Romosozumab Most Effective When Used Before Antiresorptive Drugs

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Romosozumab increases bone mineral density (BMD) most effectively when used prior to antiresorptive drugs, researchers say.

“Treatment sequence is important with romosozumab,” said Felicia Cosman, M.D., professor of medicine at Columbia University College of Physicians and Surgeons in New York City. She presented the finding at the annual meeting of the American College of Rheumatology on Saturday.

The finding provides new insight into the relationship between anabolic and antiresorptive drugs. Dr. Cosman and colleagues previously showed that another anabolic, teriparatide, increased BMD in the spine and hips when the drug was used first, followed by an antiresorptive drug, but that BMD decreased in the hips if the antiresorptive drug was used first and teriparatide was used second.

So, Dr. Cosman’s team wanted to see if a similar phenomenon was at play with romosozumab, which uses a different mechanism to promote BMD. To do this, the researchers reviewed a series of studies in which some patients were treated with romosozumab followed by either alendronate or denosumab, and others began with alendronate or denosumab and were then treated with romosozumab.

The results were striking: patients who received a one-year course of romosozumab followed by alendronate or denosumab saw a 6-6.2% increase in hip BMD. Over the course of two years, when romosozumab was followed by alendronate, patients saw a total BMD gain of 7.1% in their hips. Patients who received romosozumab followed by denosumab, experienced an overall 2-year total hip BMD gain of 8.5%.

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On the other hand, BMD gains were much lower among patients who began with alendronate or denosumab. Patients who received alendronate before romosozumab only experienced a total hip BMD increase of 2.9%, and patients who took denosumab first, only saw a BMD increase of 0.9% in the one year. Over the course of two years, when denosumab was given first, patients only experienced a BMD increase of 3.8%.

The researchers observed a similar phenomenon in spine BMD. Patients who received romosozumab first experienced a 13.1-13.7% increase in spine BMD over the course of one year and a 15.2-16.6% increase in two years.

On the other hand, patients who received romosozumab second only saw a 9.8% increase over the course of one year if they had taken alendronate first and a 5.3% increase in spine BMD if they had taken denosumab first. Over the course of two years, patients who took denosumab first experienced an 11.5% increase in spine BMD.

“Romosozumab remains effective after alendronate and possibly after denosumab,” said Dr. Cosman. “Our findings support the concept that high-risk patients should be offered an anabolic therapy first.”

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REFERENCE

ABSTRACT: 1973. “Treatment Sequences with Romosozumab Before or After Antiresorptive Medication.” The annual meeting of the American College of Rheumatology. 12:00 PM Monday, Nov. 9, 2020.