TNF inhibitors may reduce fracture risk 29% vs NSAIDs in axial spondyloarthritis
Key takeaways:
- Patients with axial SpA treated with TNF inhibitors had lower risk for hip and/or spine fracture vs. NSAIDs.
- The finding could influence shared decision-making around treatment choice.
TNF inhibitors for the treatment of axial spondyloarthritis may decrease the risk for hip or spine fracture by as much as 29% compared with NSAIDs, according to data published in Arthritis & Rheumatology.
“People with axial spondyloarthritis have double the risk for vertebral fractures and increased risk for fractures at other sites, too,” Maureen Dubreuil, MD, MSc, associate professor at the Boston University Chobanian and Avedisian School of Medicine, told Healio. “I have cared for several patients who experienced fractures, even with minor slips and falls. Fractures are often very painful but can also cause spinal cord injury and many other health complications.”
To examine how medication choices in axial SpA can impact the subsequent risk for fracture, Dubreuil and colleagues conducted a nested case-control study using the Merative MarketScan Database, a large U.S. database of people covered by employer-sponsored private health insurance. The study included 13,519 adults with either radiographic or non-radiographic axial SpA, including 1,229 with fracture and 12,290 control patients. The researchers then used unconditional logistic regression to compare the odds of hip and/or spine fracture among patients receiving TNF inhibitors or conventional synthetic disease-modifying antirheumatic drugs with those receiving NSAIDs.
Overall, 25.1% of patients with fractures received TNF inhibitors, 9.4% received conventional synthetic DMARDs and 17.9% received NSAIDs, while 47.6% received no medication. The average baseline age of those with fractures was 52.7 years vs. 47.1 years among controls, and follow-up ended at age 65 years due to Medicare eligibility.
Compared with patients on NSAIDs, those using TNF inhibitors demonstrated 29% lower odds of fracture (OR = 0.71; 95% CI, 0.59-0.85) after adjusting for age, sex and diagnosis year. Similar odds were observed with another model similarly adjusted for lifestyle, comorbidities and clinical factors (OR = 0.75; 95% CI, 0.62-0.91).
“This lower fracture risk may be a factor to consider as part of shared decision-making around axial SpA treatment,” Dubreuil said. “Although the primary goal of axial SpA treatment is usually to control the pain and stiffness associated with the disease, some people with axial SpA and their health care providers may use this information about fracture risk to help select a treatment.”
For patients receiving conventional synthetic DMARDs, there were no statistically significant differences in the odds of fracture vs. NSAIDs in either model.
The results were not altogether unexpected, according to Dubreuil.
“These findings were not too surprising, because prior literature has shown that TNF inhibitors have several benefits when used by people with axial SpA,” she said. “They improve symptoms of axial SpA — pain and stiffness — they improve individuals’ function, they deuce spinal inflammation on MRI, and they prevent formation of extra bone, or radiographic progression, on imaging. It makes sense that if people with axial SpA feel better, move better and bone architecture is improved, that risk of fracture would be lower.”
For more information:
Maureen Dubreuil, MD, MSc, can be reached at mdubreui@bu.edu; X (Twitter): @Spondy_MD.
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Driscoll D, et al. Arthritis Rheumatol. 2024;doi:10.1002/art.43082.