Efficacy, Safety and Tolerability of Denosumab in the Treatment of Rheumatoid Arthritis

Fifteen sites in each wrist and 10 sites in each hand were assessed by a blinded and independent reader. Each site was scored from 0 to 10 (in accordance with the European League Against Rheumatism [EULAR]-Outcome Measures in Rheumatology Clinical Trials convention), with each unit increment representing 10% incremental loss of the peripheral 1 cm of articular bone. The Erosion Score is a sum of erosion scores from 50 joint sites in both hands/wrists and ranges from 0 (normal, no erosion) to 500 (worst possible erosion).

TSS is the sum of erosion and joint space narrowing scores obtained from radiographs of the hands and feet, assessed by 2 independent readers. The joint erosion score is a summary of erosion severity in 32 joints of the hands and 12 joints in the feet. Each joint was scored, according to the surface area involved, from 0 (no erosion) to 5 (extensive loss of bone from more than one half of the articulating bone). Because each side of a foot joint was graded on this scale, the maximum erosion score for a foot joint was 10 and the maximal erosion score was 280. Joint Space Narrowing (JSN) Score summarizes the severity of JSN in 30 joints of the hands and 12 joints of the feet. Assessment of JSN for each hand (15 joints per hand) and foot (6 joints per foot), including subluxation, was scored from 0 (normal JSN) to 4 (complete loss of joint space, bony ankylosis, or luxation), with a maximum JSN score of 168. The TSS ranged from 0 (normal) to 448 (worst).

TSS is the sum of erosion and joint space narrowing scores obtained from radiographs of the hands and feet, assessed by 2 independent readers. The joint erosion score is a summary of erosion severity in 32 joints of the hands and 12 joints in the feet. Each joint was scored, according to the surface area involved, from 0 (no erosion) to 5 (extensive loss of bone from more than one half of the articulating bone). Because each side of a foot joint was graded on this scale, the maximum erosion score for a foot joint was 10 and the maximal erosion score was 280. Joint Space Narrowing (JSN) Score summarizes the severity of JSN in 30 joints of the hands and 12 joints of the feet. Assessment of JSN for each hand (15 joints per hand) and foot (6 joints per foot), including subluxation, was scored from 0 (normal JSN) to 4 (complete loss of joint space, bony ankylosis, or luxation), with a maximum JSN score of 168. The TSS ranged from 0 (normal) to 448 (worst).

The joint erosion score is a summary of erosion severity in 32 joints of the hands and 12 joints in the feet, obtained from radiographs of the hands and feet and assessed by 2 independent readers. Each joint was scored, according to the surface area involved, from 0 (no erosion) to 5 (extensive loss of bone from more than one half of the articulating bone). Because each side of a foot joint was graded on this scale, the maximum erosion score for a foot joint was 10 and the maximal erosion score was 280.

The joint erosion score is a summary of erosion severity in 32 joints of the hands and 12 joints in the feet, obtained from radiographs of the hands and feet and assessed by 2 independent readers. Each joint was scored, according to the surface area involved, from 0 (no erosion) to 5 (extensive loss of bone from more than one half of the articulating bone). Because each side of a foot joint was graded on this scale, the maximum erosion score for a foot joint was 10 and the maximal erosion score was 280.

Joint Space Narrowing (JSN) Score summarizes the severity of JSN in 30 joints of the hands and 12 joints of the feet obtained from radiographs of the hands and feet and assessed by 2 independent readers. Assessment of JSN for each hand (15 joints per hand) and foot (6 joints per foot), including subluxation, was scored from 0 (normal JSN) to 4 (complete loss of joint space, bony ankylosis, or luxation), with a maximum JSN score (indicating worst joint space narrowing) of 168.

Joint Space Narrowing (JSN) Score summarizes the severity of JSN in 30 joints of the hands and 12 joints of the feet obtained from radiographs of the hands and feet and assessed by 2 independent readers. Assessment of JSN for each hand (15 joints per hand) and foot (6 joints per foot), including subluxation, was scored from 0 (normal JSN) to 4 (complete loss of joint space, bony ankylosis, or luxation), with a maximum JSN score (indicating worst joint space narrowing) of 168.

Bone Mineral Density Assessed by Dual Energy X-Ray Absorptiometry. Percent change from baseline to Month 1 calculated using ((month 1 value - baseline value) / baseline value ) x 100. Least squares means are based on a repeated measures model adjusting for treatment, visit, baseline value, and strata (4 strata from the combination of baseline use of steroid and previous use of biologic).

Bone Mineral Density Assessed by Dual Energy X-Ray Absorptiometry. Percent change from baseline to month 6 calculated using ((month 6 value - baseline value) / baseline value ) x 100. Least squares means are based on a repeated measures model adjusting for treatment, visit, baseline value, and strata (4 strata from the combination of baseline use of steroid and previous use of biologic).

Bone Mineral Density Assessed by Dual Energy X-Ray Absorptiometry. Percent change from baseline to Month 12 calculated using ((Month 12 value - baseline value) / baseline value ) x 100. Least squares means based on repeated measures model adjusting for treatment, visit, baseline value, and strata (4 strata from the combination of baseline use of steroid and previous use of biologic).

Bone Mineral Density Assessed by Dual Energy X-Ray Absorptiometry. Percent change from baseline to Month 1 calculated using ((Month 1 value - baseline value) / baseline value ) x 100.

Least squares means based on repeated measures model adjusting for treatment, visit, baseline value, and strata (4 strata from the combination of baseline use of steroid and previous use of biologic).

Bone Mineral Density Assessed by Dual Energy X-Ray Absorptiometry. Percent change from baseline to Month 6 calculated using ((Month 6 value - baseline value) / baseline value ) x 100. Least squares means based on repeated measures model adjusting for treatment, visit, baseline value, and strata (4 strata from the combination of baseline use of steroid and previous use of biologic).

Bone Mineral Density Assessed by Dual Energy X-Ray Absorptiometry. Percent change from baseline to Month 12 calculated using ((Month 12 value - baseline value) / baseline value ) x 100. Least squares means based on repeated measures model adjusting for treatment, visit, baseline value, and strata (4 strata from the combination of baseline use of steroid and previous use of biologic).

Bone Mineral Density Assessed by Dual Energy X-Ray Absorptiometry. Percent change from baseline to Month 1 calculated using ((Month 1 value - baseline value) / baseline value ) x 100. Least squares means based on repeated measures model adjusting for treatment, visit, baseline value, and strata (4 strata from the combination of baseline use of steroid and previous use of biologic).

Bone Mineral Density Assessed by Dual Energy X-Ray Absorptiometry. Percent change from baseline to Month 6 calculated using ((Month 6 value - baseline value) / baseline value ) x 100. Least squares means based on repeated measures model adjusting for treatment, visit, baseline value, and strata (4 strata from the combination of baseline use of steroid and previous use of biologic).

Bone Mineral Density Assessed by Dual Energy X-Ray Absorptiometry. Percent change from baseline to Month 12 calculated using ((Month 12 value - baseline value) / baseline value ) x 100. Least squares means based on repeated measures model adjusting for treatment, visit, baseline value, and strata (4 strata from the combination of baseline use of steroid and previous use of biologic).

Percent change from baseline to Month 3 in serum Collagen C-Telopeptide (CTX) Type I calculated using ((Month 3 value - Baseline value) / Baseline value ) x 100.

Percent change from baseline to Month 6 in serum Collagen C-Telopeptide (CTX) Type I calculated using ((Month 6 value - Baseline value) / Baseline value ) x 100.

Percent change from Baseline to Month 12 in serum C-Telopeptide (CTX) Type I calculated using ((Month 12 value - Baseline value) / Baseline value ) x 100.

Percent change from baseline to Month 3 in procollagen 1 N-terminal peptide (P1NP) calculated using ((Month 3 value - Baseline value) / Baseline value ) x 100.

Percent change from baseline to Month 6 in procollagen 1 N-terminal peptide (P1NP) calculated using ((Month 6 value - Baseline value) / Baseline value ) x 100.

Percent change from baseline to Month 12 in procollagen 1 N-terminal peptide (P1NP) calculated using ((Month 12 value - Baseline value) / Baseline value ) x 100.

Percent change from baseline to Month 3 in urine Type II collagen C-Telopeptide (CTX)/Creatinine calculated using ((Month 3 value - Baseline value) / Baseline value ) x 100.

Percent change from baseline to Month 6 in urine Type II collagen C-Telopeptide (CTX)/Creatinine calculated using ((Month 6 value - Baseline value) / Baseline value ) x 100.

Percent change from baseline to Month 12 in urine Type II collagen C-Telopeptide (CTX)/Creatinine calculated using ((Month 12 value - Baseline value) / Baseline value ) x 100.

Serum from participants was tested for antibodies to denosumab by immuoassay at months 1, 3, 6 and 12. The number of participants with anti-denosumab antibodies at any assessment is reported.

Serum from participants testing positive for anti-denosumab binding antibodies was tested in a cell-based bioassay for neutralizing activity against denosumab.

Laboratory Chemistry Albumin

Laboratory chemistry albumin

Laboratory chemistry albumin

Laboratory chemistry albumin

Laboratory chemistry alkaline phoshatatse

Laboratory chemisrty alkaline phosphatase

Laboratory chemistry alkaline phosphatase

Laboratory chemistry alkaline phosphatase

Laboratory chemistry bicarbonate

Laboratory chemistry bicarbonate

Laboratory chemistry bicarbonate

Laboratory chemistry bicarbonate

Laboratory chemistry total bilirubin

Laboratory chemistry total bilirubin

Laboratory chemistry total bilirubin

Laboratory chemistry total bilirubin

Laboratory chemistry blood urea nitrogen

Laboratory chemistry blood urea nitrogen

Laboratory chemistry blood urea nitrogen

Laboratory chemistry blood urea nitrogen

Laboratory chemistry calcium

Laboratory chemistry calcium

Laboratory chemistry calcium

Laboratory chemistry calcium

Laboratory chemistry albumin-adjusted calcium

Laboratory chemistry albumin-adjusted calcium

Laboratory chemistry albumin-adjusted calcium

Laboratory chemistry albumin-adjusted calcium

Laboratory chemistry chloride

Laboratory chemistry chloride

Laboratory chemistry chloride

Laboratory chemistry chloride

Laboratory chemistry creatinine

Laboratory chemistry creatinine

Laboratory chemistry creatinine

Laboratory chemistry creatinine

Laboratory chemistry gamma-glutamyl transferase

Laboratory chemistry gamma-glutamyl transferase

Laboratory chemistry gamma-glutamyl transferase

Laboratory chemistry gamma-glutamyl transferase

Laboratory chemistry glucose

Laboratory chemistry glucose

Laboratory chemistry glucose

Laboratory chemistry glucose

Laboratory chemistry potassium

Laboratory chemistry potassium

Laboratory chemistry potassium

Laboratory chemistry potassium

Laboratory chemistry magnesium

Laboratory chemistry magnesium

Laboratory chemistry magnesium

Laboratory chemistry magnesium

Laboratory chemistry sodium

Change From Baseline in Sodium at Month 3

Laboratory chemistry sodium

Laboratory chemistry sodium

Laboratory chemistry phosphorus

Laboratory chemistry phosphorus

Laboratory chemistry phosphorus

Change From Baseline in Phosphorus at Month 12

Laboratory chemistry total protein

Laboratory chemistry total protein

Laboratory chemistry total protein

Laboratory chemistry total protein

Laboratory chemistry aspartate amino transferase

Laboratory chemistry aspartate amino transferase

Laboratory chemistry aspartate amino transferase

Laboratory chemistry aspartate amino transferase

Laboratory chemistry alanine amino transferase

Laboratory Chemistry alanine amino transferase

Laboratory chemistry alanine amino transferase

Laboratory chemistry alanine amino transferase

Laboratory hematology basophils

Laboratory hematology basophils

Laboratory hematology basophils

Laboratory hematology basophils

Laboratory hematology eosinophils

Laboratory hematology eosinophils

Laboratory hematology eosinophils

Laboratory hematology eosinophils

Laboratory hematology hematocrit

Laboratory hematology hematocrit

Laboratory hematology hematocrit

Laboratory hematology hematocrit

Laboratory hematology hemoglobin

Laboratory hematology hemoglobin

Laboratory hematology hemoglobin

Laboratory hematology hemoglobin

Laboratory hematology lymphocytes

Laboratory hematology lymphocytes

Laboratory hematology lymphocytes

Laboratory hematology lymphocytes

Laboratory hematology monocytes

Laboratory hematology monocytes

Laboratory hematology monocytes

Laboratory hematology monocytes

Laboratory hematology total neutrophils

Laboratory hematology total neutrophils

Laboratory hematology total neutrophils

Laboratory hematology total neutrophils

Laboratory hematology platelets

Laboratory hematology platelets

Laboratory hematology platelets

Laboratory hematology platelets

Laboratory hematology red blood cells

Laboratory hematology red blood cells

Laboratory hematology red blood cells

Laboratory hematology red blood cells

Laboratory hematology white blood cells

Laboratpry hematology white blood cells

Laboratory hematology white blood cells

Laboratory hematology white blood cells

Participants with laboratory toxicity of grade 3 or 4, graded according to the Common Terminology Criteria for Adverse Events, version 3.0, on the following general guideline:

Grade 1 - Mild AE; Grade 2 - Moderate AE; Grade 3 - Severe AE; Grade 4 - Life-threatening or disabling AE; Grade 5 - Death related to AE.