Background Tocilizumab is a humanized anti-human IL-6 receptor monoclonal antibody that has been demonstrated to improve RA symptoms. However, it remains unclear whether the use of tocilizumab constitutes an independent risk factor for postoperative complications. Moreover, the perioperative clinical features also remain incompletely understood1)2). Therefore, more data are required to fully evaluate the influence of tocilizumab on postoperative clinical features.
Objectives To evaluate perioperative changes in Rheumatoid arthritis (RA) patients treated with tocilizumab.
Methods We collected the RA cases with tocilizumab and surgery from 1999 to 2010. The incidences of postoperative infections, delayed wound healing, and RA symptom flare-ups were extracted from the data for comparisons with patients without these postoperative events. We also evaluated the changes in CRP and body temperature in patients without postoperative complications who were normal CRP before surgery, i.e., patients without postoperative events in whom the tocilizumab level was maintained, for each duration to discontinuation before surgery.
Results A total of 161 cases (n=122) were collected. The patients had a mean age of 56.9 years, and mean disease duration of 12.8 years at operation. Joint replacement surgery was performed in 89 cases. Three patients had postoperative infections, 20 had delayed wound healing, and 36 had RA symptom flare-ups. Delayed wound healing occurred most commonly in patients who underwent spinal surgery (P=0.0061, vs. patients without delayed wound healing). CRP levels were high when tocilizumab was restarted in patients with RA symptom flare-ups (P=0.0010, vs. patients without RA symptom flare-ups). Increased postoperative CRP was observed in patients without postoperative events when the duration from final tocilizumab infusion to surgery was long. The changes in body temperature showed a similar trend.
Conclusions Many patients treated with tocilizumab keep a normal range of CRP even during the perioperative period. For prevention of perioperative complications, observation of postoperative conditions and surgical wounds, and subjective symptoms of patients are considered important.
Hirao M, Hashimoto J, Tsuboi H, et al. Laboratory and febrile features after joint surgery in patients with rheumatoid arthritis treated with tocilizumab. Ann Rheum Dis. 2009; 68(5):654-657.
Hiroshima R, Kawakami K, Iwamoto T, et al. Analysis of C-reactive protein levels and febrile tendency after joint surgery in rheumatoid arthritis patients treated with a perioperative 4-week interruption of tocilizumab. Mod Rheumatol. 2011; 21(1):109-111.
Disclosure of Interest S. Momohara Speakers Bureau: Abbott Japan Co. Ltd., Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Santen Pharmaceutical Co. Ltd., and Mitsubishi Tanabe Pharma Corporation, J. Hashimoto Speakers Bureau: Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Santen Pharmaceutical Co. Ltd., Takeda Pharmaceutical Co. Ltd.,and Mitsubishi Tanabe Pharma Corporation, T. Suguro Speakers Bureau: Abbott Japan Co. Ltd., Bristol-Myers Squibb, Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Pfizer Inc., Santen Pharmaceutical Co. Ltd., Takeda Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corporation, and Janssen Pharmaceutical K.K.