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Nonvertebral Fracture Risk Similar Across DMARDs for RA

An analysis of real-world claims data found no major differences in the risk of nonvertebral osteoporotic fractures (NVFs) across 9 biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) for rheumatoid arthritis (RA). Researchers published their findings online ahead of print in ACR Open Rheumatology.

“These findings may be reassuring to physicians prescribing b/tsDMARDs to patients with rheumatoid arthritis, particularly those at the higher risk of nonvertebral osteoporotic fractures,” wrote researchers from Brigham and Women’s Hospital and Harvard Medical School in Boston.

The study included 134,693 adults with rheumatoid arthritis from Optum, Medicare, and MarketScan databases who initiated treatment with abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab, and tofacitinib. Adalimumab was chosen as the reference drug because it was the most commonly used by patients.

The study identified the following adjusted hazard ratios for a composite of incident NVFs (such as hip, humerus, pelvis, and wrist fractures) compared with treatment with adalimumab: 1.03 with abatacept, 1.08 with certolizumab, 1.12 with etanercept, 0.91 with golimumab, 1.03 with infliximab, 1.07 with rituximab, 1.24 with tocilizumab, and 1.07 with tofacitinib.

Secondary analyses of patients switching from a tumor necrosis factor inhibitor to a different b/tsDMARD revealed similar results, researchers reported.

“In conclusion, this large multidatabase real-world study of 134,693 patients with rheumatoid arthritis initiating b/tsDMARDs provides comprehensive assessment of risk of nonvertebral osteoporotic fractures across nine different agents,” researchers wrote. “We found no significant differences in the risk of nonvertebral osteoporotic fracture in the new users of or new switchers to 8 b/tsDMARDs compared with adalimumab.”

 

—Jolynn Tumolo

 

Reference:

Pawar A, Desai RJ, He M, Bessette L, Kim SC. Comparative risk of nonvertebral fractures among patients with rheumatoid arthritis treated with biologic or targeted synthetic disease-modifying antirheumatic drugs. ACR Open Rheumatology. Published online ahead of print. July 1, 2021.

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