A comprehensive study utilizing a large US insurance claims database has demonstrated that TNF inhibitors offer superior protection against hip and spine fractures in patients with axial spondyloarthritis (axSpA) compared to other medications. The research involved 13,519 axSpA patients aged 18-65, including 1,229 who experienced hip or spine fractures and 12,290 controls without fractures.
Key Findings:
- TNF inhibitor users exhibited a 25% lower risk for hip and spine fractures (adjusted odds ratio [aOR], 0.75; 95% CI, 0.62-0.91) than those using NSAIDs.
- The protective effect was consistent across both genders, with no significant difference observed between women and men.
- Specifically, the risk for spine fractures was 19% lower in TNF inhibitor users compared to NSAID users (aOR, 0.81; 95% CI, 0.66-0.99).
- Patients with a history of prior fractures also showed a trend towards reduced fracture risk with TNF inhibitors, although this finding was not statistically significant.
Implications:
The study underscores the multifaceted benefits of TNF inhibitors in managing axSpA, not only in controlling disease activity but also in reducing the risk of debilitating fractures. This adds a critical dimension to the therapeutic considerations for axSpA patients, particularly those at higher risk of fractures.
Study Limitations:
- The reliance on diagnostic and procedure codes for identifying axSpA and fracture outcomes may have led to misclassification.
- The absence of detailed disease activity levels and high rates of missing data for body mass index, a significant confounder for fracture risk, could introduce bias.
- The study faced limitations in analyzing hip fractures separately due to insufficient numbers.
Conclusion:
This research, led by Devin Driscoll, MD, and published in Arthritis & Rheumatology, highlights the importance of considering TNF inhibitors in the treatment regimen for axSpA patients, especially for those concerned about fracture risk. The study was supported by grants from the National Institutes of Health and involved authors with various affiliations and disclosures related to the pharmaceutical industry.
