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Rheumatology (Oxford). 2019 Jun 1;58(6):997-1005. doi: 10.1093/rheumatology/key416.

Efficacy of denosumab with regard to bone destruction in prognostic subgroups of Japanese rheumatoid arthritis patients from the phase II DRIVE study.

Author information

Department of Orthopaedics, Nagoya University Graduate School of Medicine, Nagoya, Aichi.
First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu.
Institute of Rheumatology, Tokyo Women's Medical University, Tokyo.
Department of Biochemistry, Osaka University Graduate School of Dentistry, Osaka.
Daiichi-Sankyo Co., Ltd, Tokyo, Japan.
Departments of Radiology, Medicine and Orthopaedic Surgery, University of California, San Francisco, CA, USA.
Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.



To evaluate the efficacy of denosumab for progressive bone erosion in risk factor subgroups of Japanese RA patients.


This study included 340 RA patients on MTX from the dose-response study of Denosumab in patients with RheumatoId arthritis on methotrexate to Validate inhibitory effect on bone Erosion (DRIVE study-a 12-month, multicentre, randomized, double-blind, placebo-controlled, phase II study). The patients were randomized to receive placebo or denosumab 60 mg every 6 months, 3 months or 2 months. Subgroup analyses involved baseline RF, ACPA, swollen joint count, CRP level, RA duration, ESR and glucocorticoid use.


Patients with risk factor positivity generally showed consistent results for the primary endpoint of the change in the modified Sharp erosion score at 12 months from baseline. In the placebo, every 6 months, every 3 months and every 2 months groups, the mean changes in the erosion score, according to the RF status (RF-positive vs -negative subgroups), were 1.18 vs 0.59, 0.25 (P = 0.0601 vs placebo) vs 0.31 (P = 0.0827), 0.21 (P = 0.0422) vs -0.02 (P = 0.0631) and 0.15 (P = 0.0010) vs -0.05 (P = 0.0332), respectively, while the mean changes in the erosion score, according to the ACPA status (ACPA-positive vs -negative subgroups), were 1.30 vs 0.07, 0.26 (P = 0.0142) vs 0.33 (P = 0.2748), 0.16 (P = 0.0058) vs 0.08 (P = 0.7166) and 0.09 (P < 0.0001) vs 0.08 (P = 0.8939), respectively.


Denosumab is a potentially useful treatment option for RA patients who are positive for RF, ACPA and other possible risk factors.


JAPIC Clinical Trials Information,, JapicCTI-101263.


anti-cyclic citrullinated peptide antibody; bone erosion; denosumab; rheumatoid arthritis; rheumatoid factor; subgroup analysis

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