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The Effect of TNF Inhibition on Bone Density and Fracture Risk and of IL17 Inhibition on Radiographic Progression and Bone Density in Patients with Axial Spondyloarthritis: a Systematic Literature Review

  • Dalit AshanyEmail author
  • Emily M. Stein
  • Rie Goto
  • Susan M. Goodman
Spondyloarthritis (M Khan, Section Editor)
  • 206 Downloads
Part of the following topical collections:
  1. Topical Collection on Spondyloarthritis

Abstract

Purpose of Review

Osteoporosis in axial spondyloarthritis may be modified by therapy. The purpose of this systematic review is to describe (i) the effect of TNFi on BMD, (ii) the effect of secukinumab on BMD, and (iii) the effect of secukinumab on radiographic disease progression in axSpA.

Recent Findings

We searched PubMed, Embase, and Cochrane using the following retrieval languages: spondyloarthritis, ankylosing spondylitis, TNF, IL-17, x-rays, and osteoporosis. Twenty-nine studies were included; 27 re: TNFi and BMD, and 2 re: IL-17 blockers and x-ray progression. TNFi over 2–4 years increased BMD of the lumbar spine (3.2–14.9%) and hip (2.26–4.7%) without reducing vertebral fractures. Secukinumab reduced radiographic progression; none (73%) and minimal (79%) at 4 years. No data on IL-17 blockade and bone were found.

Summary

TNFi therapy improves bone density but not vertebral fracture rates. Secukinumab improves symptoms and may slow radiographic progression. Data is lacking regarding the effects of secukinumab on BMD and fractures. These are important questions which may impact the choice of therapy.

Keywords

Axial spondyloarthritis Ankylosing spondylitis Osteoporosis Bone density TNF inhibitors IL-17 Secukinumab Radiographic progress Vertebral fracture 

Abbreviations

axSpA

Axial spondyloarthritis

AS

Ankylosing spondylitis

TNFi

Tumor necrosis factor (TNF) inhibitor

RCT

Randomized control trial

PRISMA

Preferred reporting items for systematic review and meta-analysis

mSASSS

Modified Stoke Ankylosing Spondylitis Spinal Score

ACR

American College of Rheumatology

LS

Lumbar spine

TH

Total hip

FN

Femoral neck

VFx

Vertebral fractures

OTW

Occiput to wall

BASFI

Bath Ankylosing Spondylitis Functional Index

VEs

Vertebral edges

Notes

Acknowledgements

The authors thank Haley Tornberg—research assistant.

Authors’ Contributions

DA, EMS, and SMG contributed to the conception and design of the review and assessed all papers, data extraction, and quality assessment. DA, EMG, RG, and SMG performed the literature search. DA drafted the paper; EMS and SMG revised the article for important intellectual content. All authors gave final approval of the version to be published.

Compliance with Ethical Standards

Conflict of Interest

Dr. Goodman reports grants from Novartis, personal fees from Novartis, personal fees from Pfizer, personal fees from UCB, grants from Horizon, outside the submitted work.

Dr. Ashany reports grants from Novartis, outside the submitted work.

Emily M. Stein and Rie Goto declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Ethics Approval and Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Dalit Ashany
    • 1
    Email author
  • Emily M. Stein
    • 1
  • Rie Goto
    • 1
  • Susan M. Goodman
    • 1
  1. 1.Department of Rheumatology, Hospital for Special Surgery Hospital for Special SurgeryWeill- Cornell Medical SchoolNew YorkUSA

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