TNF Inhibitor Treatment Reduces Fracture Risk in Axial Spondyloarthritis
A new nested case-control study published in Arthritis Rheumatology has shed light on the impact of different treatments on fracture risk in patients with axial spondyloarthritis (axSpA), a condition known for its increased fracture risk due to chronic inflammation. The study assessed the relationship between treatment with tumor necrosis factor inhibitors (TNFi), nonbiologic conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and nonsteroidal anti-inflammatory drugs (NSAIDs) on the likelihood of hip and spine fractures.
Drawing data from the MerativeTM MarketScan Database (2006-2021), the study included 13,519 axSpA patients, with 1,229 cases of fractures and 12,290 controls. The results revealed that patients on TNFi treatment had a 29% lower risk of fractures compared to those taking NSAIDs (odds ratio [OR] 0.71, 95% CI 0.59-0.85). This protective effect remained consistent even after fully adjusting for confounders such as age, sex, and diagnosis year (OR 0.75, 95% CI 0.62-0.91).
The analysis also showed that the positive impact of TNFi on fracture risk was similar across both male and female patients, further emphasizing the therapeutic potential of TNFi in mitigating the bone-related complications of axSpA. These findings support the growing understanding that TNFi not only alleviates inflammation in axSpA but may also help reduce the comorbidities associated with the disease, including fractures.
This large-scale study contributes valuable evidence on the role of TNFi in managing axSpA and its associated risks, paving the way for more targeted treatment strategies to improve bone health in these patients.
Reference
Driscoll D, George N, Peloquin C, Jafarzadeh SR, Liew JW, Dubreuil M. Association of Therapies for Axial Spondyloarthritis on the Risk of Hip and Spine Fractures. Arthritis Rheumatol. Published online December 16, 2024. doi:10.1002/art.43082
