Infliximab ( Remicade ) has been shown to have beneficial effects on bone metabolism in patients with Crohn's disease ( CD ) although as yet the exact mechanisms have not been fully elucidated.
A study has evaluated the impact of Adalimumab ( Humira ) therapy on bone metabolism using a combined in vivo and in vitro model.
Parathyroid hormone, vitamin D, bone formation markers, bone resorption marker, pro-inflammatory cytokines, anti-inflammatory cytokines, osteoprotegerin, and sRANKL were measured in control patients and pre- and post-treatment with Adalimumab in patients with Crohn's disease.
The effect of control patients' and pre- and post-treatment CD patients' sera on human osteoblasts ( hFOB 1.19 ) in vitro cell viability and differentiation was also analyzed.
There was a significant increase in bone formation markers osteocalcin ( P less than 0.05 ) and procollagen type 1 N-terminal propeptide ( P less than 0.01 ) at 1 and 3 months post-treatment.
Moreover, there was a sustained but not significant fall in serum collagen type 1 cross-linked C-telopeptide ( CTx ), a bone resorption marker.
No significant change was seen over time with other parameters measured.
Serum from patients with Crohn's disease, pre-treated with Adalimumab, showed increased osteoblast viability compared with that of post-treated patients at 6 months ( P = 0.002 ) and controls.
However, post-Adalimumab treatment sera at 6 months appeared to increase osteoblast differentiation ( P = 0.001 ), which is likely to be important in new bone formation.
In conclusion, this first study evaluating the role of Adalimumab as a possible bone protector in Crohn's disease patients has shown that similar to Infliximab, Adalimumab has complex and potentially beneficial effects on bone metabolism. ( Xagena )
Veerappan SG et al, Dig Dis Sci 2015;60:2119-2129