Impact of romosozumab treatment for 24 months after switching from denosumab: three case reports

초록

Prior denosumab use in osteoporosis patients diminishes the BMD gains from a subsequent 12-mo romosozumab regimen. However, few studies have explored BMD gains after 24 mo of romosozumab therapy. BMD at the LS-BMD, FN-BMD, and TH-BMD and P1NP and C-terminal telopeptide of type I collagen (CTX) levels were measured after 24 mo of romosozumab therapy in 3 osteoporosis cases with prior denosumab use. The changes in cases 1-3 at 12 and 24 mo, respectively, were as follows: LS-BMD (-2.9% and 7.4%, 0.9% and 7.9%, 7.2% and 7.9%), FN-BMD (3.2% and 7.1%, -1.2% and 2.0%, 2.7% and 2.1%), and TH-BMD (-1.2% and 6.7%, -4.9% and -0.3%, -0.3% and 3.2%). The P1NP and CTX levels in case 1 (18.80 ng/mL, 0.042 ng/mL) peaked at 6 mo (185.00 ng/mL, 1.280 ng/mL) and then decreased at 24 mo by 60.8% and 65.3%, respectively. The P1NP and CTX levels in case 2 (17.10 ng/mL, 0.059 ng/mL) peaked at 12 mo (132.00 ng/mL, 1.190 ng/mL) and then decreased at 24 mo by 65.3% and 24.3%, respectively. In case 3, the P1NP and CTX levels (56.10 ng/mL, 0.490 ng/mL) increased at 24 mo by 233.3% and 375.5%, respectively. This is the first report of a 24-mo romosozumab regimen in a small group of osteoporosis patients with prior denosumab use having varied effects on BMD and bone turnover. Nonetheless, larger controlled studies are needed to confirm these findings. Despite limited gains in BMD with 12-mo romosozumab therapy following prior denosumab use, the effects of extending romosozumab therapy to 24 mo remain unclear. In contrast to 12-mo therapy, which resulted in a continuous increase in bone turnover but no significant hip BMD gains, the 24-mo therapy resulted in a subsequent peak in bone turnover and significant hip BMD gains in 2 cases. These findings suggest that longer romosozumab therapy can have varied effects on BMD and bone turnover.

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