TNFi Therapy Affects Osteogenic Factors in Axial Spondyloarthritis

Tumor necrosis factor inhibitor (TNFi) therapy can rapidly change osteogenic factors in patients with axial spondyloarthritis (axSpA),¹ according to research results presented at the American Society for Bone and Mineral Research 2019 Annual Meeting, held September 20 to 23, 2019, in Orlando, Florida.

Researchers conducted a prospective study to describe changes in serum levels of osteogenic factors, including bone morphogenetic protein 7 (BMP7), sclerostin, and Dickkopf-1, over 5 years in patients with early axSpA (patients of >3 months and <3 years).

Data were collected from the DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort,² a prospective, multicenter French study including 708 patients (age range, 34±9 years; 58% human leukocyte antigen B27 positive) with early inflammatory back pain suggestive of axSpA. Investigators measured BMP7, sclerostin, and Dickkopf-1 serum levels at baseline, 2 years, and 5 years follow-up. Using mixed linear models, changes in bone formation regulators and determinants of these changes were analyzed.

Overall, serum BMP7 increased significantly over time (mean, 0.17 pg/mL/month). At 5 years, the median relative change was 53.0% (interquartile range [IQR], -31.6% to 286.8%). Nearly 60% (n=337) of patients had serum levels that were undetectable at baseline, 48.0% (n=111) of patients at 2 years, and 20.2% (n=59) of patients had undetectable serum levels at 5 years.

Baseline serum sclerostin levels were “significantly correlated” with age, weight, syndesmophyte number, and hip and lumbar spine bone mineral density. Serum sclerostin significantly increased over time, with a mean of 0.001 ng/mL/month; at 5 years, the median relative change was 14.8% (IQR, -7.9% to 41.4%). Serum Dickkopf-1 did not change significantly over time.

Multivariate analysis indicated that serum BMP7 increased with moderate or high disease activity and did not increase significantly over time in relation to the duration of TNFi use (-0.04/month, P <.001).

References

1. Descamps E, Molto A, Borderie D, et al. Large increase of BMP-7 in early axial spondyloarthritis. Presented at: 2019 American Society for Bone and Mineral Research 2019 Annual Meeting; September 20-23, 2019; Orlando, FL, USA. Abstract 433.

2. Dougados M, d’Agostino M-A, Benessiano J, et al. The DESIR cohort: A 10-year follow-up of early inflammatory back pain in France: Study design and baseline characteristics of the 708 recruited patients. Joint Bone Spine. 2011;78(6):598-603.