Comparison of romosozumab versus denosumab treatment on bone mineral density after 1 year in rheumatoid arthritis patients with severe osteoporosis: A randomized clinical pilot study

Objectives To investigate the effect of romosozumab versus denosumab treatment on bone mineral density (BMD), disease activity, and joint damage in patients with rheumatoid arthritis and severe osteoporosis. Methods Fifty-one postmenopausal women were enrolled and randomized equally into two groups to receive either romosozumab or the denosumab. Changes (Delta) in the BMD (at lumbar spine, total hip, and femoral neck), disease activity score in 28 joints (DAS28)-erythrocyte sedimentation rate (ESR), and van der Heijde-modified Total Sharp Score (TSS) from baseline to 12 months after treatment were evaluated. Results The Delta BMD at 12 months in the romosozumab and denosumab groups were 10.2 +/- 5.6% and 5.0 +/- 3.1% (p = .002) for the lumbar spine, 3.7 +/- 4.9% and 3.5 +/- 3.0% (p = .902) for the total hip, and 3.6 +/- 4.7% and 3.2 +/- 4.9% (p = .817) for the femoral neck, respectively. The Delta DAS28-ESR and Delta TSS at 12 months did not differ between these two groups. Conclusions Our results suggest that romosozumab treatment was more effective in increasing the BMD at the lumbar spine than denosumab and may be selected for patients who require a significant increase in the lumbar spine BMD.