Background Cervical lesions are known to occur at high frequency as a complication of rheumatoid arthritis (RA). Treatment with biological agents are more clinically effective than the DMARDs that were in use previously, in particular, with their efficacy in suppressing joint destruction having been emphasized. We reported the efficacy of infliximab (IFX), anti-tumor necrosis factor antibodies for inhibiting the radiographic progression of RA cervical lesions at ACR2009, EULAR 2010, 11 and 12. However there is still no studies of efficacy of against RA cervical lesions of Tocilizumab (TCZ), anti-interleukin 6 receptor antibody.
Objectives To elucidate the efficacy of TCZ for inhibiting the radiographic progression of RA cervical lesions.
Methods We used TCZ and IFX for treating each 270 and 604 Japanese patients with active RA who fulfilled the ACR criteria in 1987. The final study cohort of each 42 and 126 patients received continuous TCZ and IFX treatment for at least 1 year. The TCZ dose was 8 mg/kg. The later doses were administered every 4 weeks up to Week 52. For evaluation of cervical lesions, the atlanto-dental interval (ADI), the space available for the spinal cord (SAC), and the Ranawat value were measured by plain lateral radiographs in the flexion position, at initiation and Week 52. For evaluation of hand joint lesions, simple X-radiography of both surfaces of the hands was carried out, and joint destruction was evaluated using the Sharp/Van der Heijde Score (SHS) at initiation and Week 52.
Results In the TCZ (n=42) and IFX patients (n = 126), the respective changes in cervical lesion parameters in 1 year were as follows: ADI: 0.29 ± 0.51 and 0.23 ± 0.46 mm (p = 0.517); SAC: −0.24 ± 0.43 and −0.21 ± 0.45 mm (p = 0.621); and Ranawat value: −0.21 ± 0.42 and −0.21 ± 0.45 mm (p = 0.862). The number who was able to inhibit progression in all three parameters were each 29 cases (69%) receiving TCZ and 89 cases (71%) receiving IFX (p=0.848). At Week 52, the disease activity of all patients receiving TCZ on the basis of the CDAI criteria were remission, low, moderate and high in 11, 15, 14, 2 patients, respectively. In the remission patients (n = 11) and the low, moderate and high patients (n = 31), the respective changes in cervical lesion parameters in 1 year were as follows: ADI: 0 and 0.39 ± 0.56 mm (p = 0.024); SAC: 0 and −0.32 ± 0.48 mm (p = 0.033); and Ranawat value: 0 and −0.29 ± 0.46 mm (p = 0.046). Furthermore we investigated the changes in ADI, SAC, Ranawat value from baseline to Week 52 between non-progressive (ΔTSS≦0) and progressive patients (ΔTSS > 0) in SHS. In the non-progressive (n=14) and progressive patients (n = 28), the respective changes in cervical lesion parameters in 1 year were as follows: ADI: 0 and 0.43 ± 0.57 mm (p = 0.007); SAC: 0 and −0.36 ± 0.49 mm (p = 0.011); and Ranawat value: 0 and −0.32 ± 0.48 mm (p = 0.018).
Conclusions TCZ treatment can be used to suppress the progression of RA cervical lesions, as well as IFX treatment. 1 year after initiation, the cervical lesion did not progress at all for the patients receiving TCZ that a hand joint destruction did not progress and the remission patients of the CDAI criteria at Week 52.
Disclosure of Interest None Declared