Bone-sparing effects of rituximab and body composition analysis in a cohort of postmenopausal women affected by rheumatoid arthritis – retrospective study

Abstract

Objective: Osteoporosis is the most common bone tissue disease and it is characterized by a reduced bone mineral density (BMD). The main physiopathological mechanisms converge on the uncoupling between bone formation and resorption, thus leading to an enhanced risk of fractures. Several papers have documented the inverse relationships linking high inflammatory cytokines, anticitrullinated protein antibodies, rheumatoid factor, and BMD in rheumatoid arthritis (RA). Rituximab (RTX) is a chimeric monoclonal antibody directed against the CD20 receptor of B cells. Since the Food and Drug Administration approved it for RA in 2006, there have been many clinical experiences regarding its use. Nevertheless, few studies evaluate the effect of rituximab on BMD. RA is a disease characterized by immune dysfunction with high levels of inflammatory cytokines, autoantibodies, and it is reasonable that a B cell depleting therapy could restore a physiological cytokine balance, thus exerting an osteoprotective effect on the bone tissue. The purpose of this paper is to highlight any difference in BMD and to assess differences in body composition over a retrospective 18-month follow-up period after RTX treatment with a B cell depleting therapy. Material and methods: We analyzed by dual energy X-ray absorptiometry BMD expressed as g/cm 2 and body composition modifications over 18 months with RTX treatment of 20 postmenopausal RA patients. Results: After eighteen months of therapy with RTX, a statistically significant increase in vertebral (L1-L4) BMD and the stability of femoral BMD were documented. Conclusions: Rituximab is associated with an improvement of vertebral and preservation of femoral BMD, suggesting a bone-sparing effect due to B cell depletion. Furthermore, patients displayed a redistribution of fat masses toward the hip region.

The effect of disease-modifying anti-rheumatic drugs on skeletal muscle mass in rheumatoid arthritis patients: a systematic review with meta-analysis

“…After this process, 32 articles were included for the full-text screening. Finally, after the full-text reading, we included nine studies: Engvall et al [ 41 ] and Marcora et al [ 42 ] as randomized clinical trials and Al Khayyad et al [ 43 ], Vial et al [ 44 ], Tournadre et al [ 45 ], Toussirot et al [ 46 ], Ferraz-Amaro et al [ 47 ], Metsios et al [ 48 ], and Chikugo et al [ 34 ] as observational studies. The search and inclusion/exclusion criteria are described in Fig.…”

“…Of the nine studies included, four of them were performed in France [ 42 , 44 – 46 ], one of them in the UK [ 48 ], one in Spain [ 47 ], one in Japan [ 34 ], one in Sweden [ 41 ], and one in Italy [ 43 ]. Studies included were published between 2007 and 2020.…”

“…Among the nine papers included, the treatments used in the studies were tocilizumab [ 45 , 46 ], anti-TNF [ 47 , 48 ], JAKi [ 34 ], rituximab [ 43 ], bDMARDs [ 44 ], etanercept [ 42 ], methotrexate [ 41 , 42 ], sulfasalazine [ 41 ], and hydroxychloroquine [ 41 ].…”

“…Chikugo et al used appendicular lean mass as a parameter and showed no significant changes in this parameter after JAKi treatment (0.49%) [ 34 ]. Al Khayyat et al [ 43 ] used both lean mass and appendicular lean mass as parameters and showed a decrease (3.3%) in lean mass and an increase (10%) in appendicular lean mass. Vial el al [ 44 ].…”

The Effect of Anti-rheumatic Drugs on the Skeleton

“…Analysis of bone resorption markers did not find any significant change after 12 months of Rituximab treatment [60]. A recent small retrospective study has found that after 18 months of RTX treatment the lumbar spine BMD has significantly improved in 20 postmenopausal women with RA (+ 7%, p = 0.0029), the femoral neck BMD remained stable [61]. These results suggest that studies with a longer observation period maybe required to detect a significant BMD change.…”