Background/Purpose:  To analyze the effects of therapy with tofacitinib (Tofa), a Janus kinase inhibitor on the bone mineral density (BMD) of the lumbar spine and femoral neck in patients with rheumatoid arthritis (RA).

Methods:   Thirty-seven patients with active RA (indicated by a 28-joint disease activity score ESR > 3.2) despite treatment with methotrexate(MTX) 10mg per week were included in this open label prospective study and started on Tofa (10 mg every day). All patients used a stable dosage of MTX, and were not allowed to use steroids or bisphosphonates during the study period. The BMD of the lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry at baseline and 52 weeks after initiating Tofa. The least significant detectable difference of lumbar spine and femur neck was +/-0.02.

Results:   Thirty-one patients completed this study. The BMD of the lumbar spine and femoral neck remained stable after 1 year of Tofa treatment. In 11 patients who had osteopenia at baseline, there was a significant increase in the BMD of the lumbar spine (0.021 ± 0.034; P < 0.05) and femoral neck (0.005 ± 0.0125; P < 0.05; however it was not satisfied with detectable difference.).

Conclusion:  Tofa affects the BMD in patients who had active RA despite treatment with MTX. The BMD of the lumbar spine in patients with normal BMD at baseline was stable. TCZ increased the lumbar spine BMD of patients who had osteopenia at baseline.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-tofacitinib-on-bone-mineral-density-in-patients-with-methotrexate-resistant-active-rheumatoid-arthritis/