Posted by Phillipa on October 29, 2009, at 0:22:33
I didn't know oseoporosis and arthritis were related. This study combines the use of two drugs for bone density. Need help in interpreting as need something for mine and I've googled all categories. Thank you Phillipa
News From ACR 2009This coverage is not sanctioned by, nor a part of, the ACR. Conference news does not receive grant support and is produced independently.
From Medscape Medical News
Two Osteoporosis Drugs May Be Better Than 1 in Selected Patients
Alice Goodman
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Review the OPTIMAL Forum Steering Committee discussion. October 27, 2009 (Philadelphia, Philadelphia) The combination of zoledronic acid and teriparatide, 2 drugs with different mechanisms of action to treat osteoporosis, might be a valuable strategy in selected high-risk patients with rheumatoid arthritis and osteoporosis, according to a randomized study presented here at American College of Rheumatology (ACR) 2009.Previous studies of alendronate (a bisphosphonate that prevents bone resorption similar to, but less potent than, zoledronic acid) and teriparatide found no beneficial effect on bone mineral density (BMD), presumably because of suppression of new bone formation, explained Kenneth Saag, MD, Jane Knight Lowe Professor of Medicine at the University of Alabama, Birmingham.
The current study used 1 annual injection of zoledronic acid, which did not appear to inhibit the bone-forming effects of teriparatide.
"The combination of zoledronic acid and teriparatide is one to consider in selected high-risk patients, including those with low hip BMD, previous fractures, rheumatoid arthritis, and other serious conditions where we want to achieve a more rapid response," Dr. Saag said.
The 1-year, partial double-blinded, multicenter study enrolled 412 postmenopausal women older than 65 years with osteoporosis (BMD T-score of 2.5 standard deviations below peak bone mass) or better BMD but 1 previous bone fracture. Patients were randomized to receive 1 intravenous injection of zoledronic acid 5 mg on day 1 plus daily subcutaneous teriparatide 20 mg, or either agent alone at the same doses.
At week 52, spine BMD increase was similar for the combination group and the teriparatide group (7.51% and 7.05%, respectively); for the zoledronic acid group, spine BMD was 4.37% (P < .001 for the combination and the teriparatide group vs the zoledronic acid group).
Both combination therapy and zoledronic acid increased total hip BMD at 52 weeks, compared with teriparatide alone (P < .005).
Dr. Saag said that the combination appeared to increase BMD faster than either drug alone, as reflected by BMD measurements at different intervals over the course of the 1-year trial.
In this study, fractures were recorded as an adverse event and were rare, with no significant difference between treatment groups but with a trend favoring combination therapy over either drug alone. No significant differences in deaths, serious adverse events, or study discontinuations were reported for the 3 groups.
Results Not Unexpected
Chad Deal, MD, head of the Center for Osteoporosis and Metabolic Bone Disease at the Cleveland Clinic Foundation, in Ohio, called these data "interesting." Dr. Deal was comoderator of the session in which the results were presented.
He said that fracture rates would be an important end point in a clinical trial like this one, but noted that this study was too small to show a significant difference in fracture rates. "We are left with BMD, which is an imperfect surrogate for fracture," he said.
"This study really doesn't show what is happening to the respective treatment groups. A QTC [quantitative computed tomography] scan would have provided more accurate information on bone density than DXA [dual energy X-ray absorptiometry], which was used in this study. We know from previous trials that DXA is not nearly as accurate as a QTC," Dr. Deal said.
"I'm not surprised by these encouraging results. Osteoporosis is common in [rheumatoid arthritis], driven by uncontrolled inflammation and mediators that activate osteoclasts leading to local erosions," said Jonathan Adachi, MD, from McMaster University in Hamilton, Ontario.
Dr. Adachi said the ideal trial would be a head-to-head comparison of the concomitant therapy used in this trial and sequential therapy teriparatide for 2 years followed by zoledronic acid to determine which treatment is more effective.
Dr. Saag reports financial ties with Eli Lilly & Co, Merck, Novartis, Amgen, Roche, Procter & Gamble, Aventis, TAP, and GlaxoSmithKline. Dr. Deal reports financial ties with Novartis Pharmaceutical Corporation. Dr. Adachi reports receiving consultant fees from Novartis, Eli Lilly, Amgen, AstraZeneca, GSK-Merck, Nyocmed, Pfizer, Procter & Gamble, Sanofi-Aventis, and Servier.
American College of Rheumatology (ACR) 2009: Abstract 112-A. Presented October 18, 2009.
poster:Phillipa
thread:923258
URL: http://www.dr-bob.org/babble/20091021/msgs/923258.html