ECTS2016 Poster Presentations Other diseases of bone and mineral metabolism (52 abstracts)
Change in bone mineral density with high-dose prednisone in patients with rheumatoid arthritis
Linda Rasch 1 , Lilian van Tuyl 1 , Martijn Kremer 1 , Irene Bultink 1 , Maarten Boers 2, & Willem Lems 1,
1Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands; 2Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; 3Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.
Background: Recently, we showed that treatment with COBRA-light therapy including prednisone with initially 30 mg/day was as effective as the original COBRA scheme, with initially 60 mg/day (Ter Wee, ARD 2015), in the treatment of rheumatoid arthritis (RA). Since high-dose glucocorticoids are associated with bone loss, we investigated the differences in bone mineral density (BMD) after 1 year of treatment in both arms.
Objective: To determine whether there is a significant difference in BMD between COBRA and COBRA-light, and to determine the change in BMD between baseline and 52 weeks within these groups.
Methods: An open-label, randomised controlled, non-inferiority trial of patients with active early RA following a treat-to-target protocol.
Results: In total, 144 patients were included and randomized to either COBRA (n=71) or COBRA-light (n=73) therapy. We did not find differences in change in BMD between COBRA and COBRA-light at all sites. However, COBRA-light showed a significant decrease in BMD in the lumbar spine and total hip after 52 weeks as shown in Table 1.
| COBRA (n=71) | COBRA-light (n=73) | |||||
| Baseline | Week 52 | Change | Baseline | Week 52 | Change | |
| Lumbar spine | 1.12 (0.17) | 1.12 (0.17) | 0.01% | 1.10 (0.15) | 1.09 (0.15) | −1.02%* |
| Total hip | 0.95 (0.14) | 0.95 (0.14) | 0.05% | 0.95 (0.12) | 0.94 (0.13) | −1.16%* |
| Femoral neck | 0.90 (0.16) | 0.89 (0.17) | −0.59% | 0.88 (0.12) | 0.87 (0.11) | −0.98%* |
| *Significant change between baseline and week 52 (P<0.05). Values are reported as mean (SD), unless otherwise specified. | ||||||
Conclusion: No difference in change in BMD between COBRA and COBRA-light was found. The overall bone loss was small, which suggests that the negative effects of (high-dose) prednisone on bone might be counteracted by the large reduction in disease activity as a result of combination therapy and tight control treatment.
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