Background The IL6-antibody tolicizumab (TCZ) leads to a rapid improvement of the clinical course in patients with rheumatoid arthritis (RA) as assessed by the DAS28 score.4 However, in MR and ultrasound imaging a residual activity of the rheumatic process can still be detected.2 RA is a known risk factor for the occurence of bone fractures related to osteoporosis.3 TCZ has a positive effect on bone remodeling1 and might be useful to prevent RA related bone fractures.
Objectives The purpose of this analysis was to investigate the effect of TCZ on bone remodeling in patients with severe RA.
Methods 50 patients with RA treated with TCZ as monotherapy since 2008 were prospectively analyzed. Ultrasound was performed and the DAS28 was determined at baseline and every 4 weeks thereafter. Lab parameters investigating bone metabolism, protein diagnostics and MRI were performed at baseline and every 6 months thereafter. Once a year patients underwent CT and DXA scan.
Results In all 50 patients (age 20-72 years, 33 female), the DAS28 score normalized at the latest by the 3rd infusion cycle. An initial MRI RAMSIS score >5 was reduced to ≤2 after 6 to 18 months. The ultrasound score for synovialitis declined after 8 weeks and after 12 months for tenosynovialitis. At baseline in 22 women with early RA, axial QCT/DXA values and lateral DXA values within the reference range were documented. 3 patients with early RA had osteopenia, 2 has osteoporosis. 1 patient with manifest RA had a BMD in the reference range, 3 had osteopenia and 2 were diagnosed with osteoporosis. In 6 male patients, BMD values were within the reference range. 2 men with early RA had osteopenia and 2 had osteoporosis. In 1 male patient with manifest RA, normal BMD values were documented. 2 men with manifest RA hat osteopenia and 4 had osteoporosis. 10 patients had vitamin D3 deficiency. Vitamine D3 was substituted in these patients. 2 patients with osteoporosis were treated with bisphosphonates. In all patients, BMD values were within the reference range after 1 year of treatment with TCZ.
Conclusions Treatment with TCZ leads to a rapid decline of inflammatory activity of the affected joints in patients with RA and minimizes cartilage destruction. TCZ showed a positive effect on bone remodeling. Thus, the risk for the development of osteoporosis and its related fractures can be minimized by TCZ treatment. Furthermore, TCZ has a positive effect on BMD in manifest RA thus preventing sarcopenia.
Briot K et al.; Positive Effects of Tocilizumab On Bone Remodeling in Patients with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2012;64 Suppl 10:823
Hoehle M et al.; Synovialitis Plus Articular Cartilage Monitoring Via Magnetic Resonance Imaging and Ultrasound under Tocilizumab Therapy in Patients with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2012;64 Suppl 10:466
Christiansen C et al.; Assessement of Tissue Turnover and Quality in Rheumatology. European Congress on Osteoporosis and Osteoarthritis, ESCE013-OF, SE 18 Abstract
Specker C et al.; Tocilizumab in Rheumatoid Arthritis – One Year Interim Analysis of the Non-interventional ICHIBAN Study. Ann Rheum Dis 2012;71(Suppl3):667
Disclosure of Interest None declared