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Etanercept, a TNF-α inhibitor, does not impede fracture healing


Tumor necrosis factor α (TNF-α) is known to be expressed during the early stages of fracture healing, but the impact of TNF-α blocking therapy, increasingly used by patients with rheumatoid arthritis and other inflammatory arthrides, has not been assessed. In this study, Sandberg et al. used a rat model to investigate the impact of etanercept therapy on Achilles tendon repair and metaphyseal bone healing.

Rats were started on etanercept at a dose of 3.5 mg/kg on the day of surgery and then treated 3 times each week. Loaded and load-protected tendons (Botox treated) Achilles tendons healed equally in both groups and showed similar levels of energy uptake and stiffness. The mechanical properties of metaphyseal bone at similar time points also did not differ; in fact, the etanercept-treated rats had a significantly higher density of bone compared to controls.

Editor's comment: Studies in heterotopic ossification suggested an osteogenic effect of the TNF-α inhibitor etanercept. This study of screw integration in healing of the metaphysis and tendon showed no significant effect. It is important that no negative effect could be shown in a rodent model of this biologic agent, particularly as non-steroidal anti-inflammatory drugs have previously shown deleterious effects in this and similar models.

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