Background Cervical lesions are known to occur at high frequency as a complication of rheumatoid arthritis (RA). Treatment with biological agents are clinically effective in particular, with their efficacy in suppressing joint destruction having been emphasized. However there is still no studies of efficacy of against RA cervical lesions of Tocilizumab (TCZ), anti-interleukin 6 receptor antibody.
Objectives To evaluate the efficacy of TCZ for suppressing the radiographic progression of RA cervical lesions.
Methods We used TCZ for treating 270 Japanese patients with active RA who fulfilled the ACR criteria in 1987. The final study cohort of 52 patients received continuous TCZ treatment for at least 1 year. For evaluation of cervical lesions, ADI, SAC and the Ranawat value were measured by plain lateral radiographs, at initiation and Week 52.
Results The group of patients included 11 males and 41 females. The mean age was 53.4±12.9 years old; disease duration was 10.8±9.7 years; and the number of receiving methotrexate (MTX) was 37 (71%). Clinical findings related to RA were as follows; CRP, 3.7±2.6mg/dL; ESR, 56.1±27.0mm/h; DAS28 5.72±1.07; and CDAI, 24.7±12.7; ADI, 3.4±1.9mm; SAC, 18.9±2.7mm; Ranawat value, 14.9±2.7mm and TSS, 67.3±56.8. The numbers of patients who did not showed progression in ADI, SAC, Ranewat value and all three parameters were 37 (73%), 37 (73%), 39 (76%) and 36 (69%). In the naive (n=9) and switch patients (n=43), the respective changes in cervical lesion parameters in 1 year were as follows: ADI: 0.22±0.44 and 0.30±0.51 mm (p=0.707); SAC: −0.33±0.50 and −0.26±0.44 mm (p=0.637); and Ranawat value: −0.22±0.44 and −0.23±0.43 mm (p=0.947). In the patients of combination MTX (n=37) and non-combination MTX (n=15), the respective changes in cervical lesion parameters in 1 year were as follows: ADI: 0.32±0.53 and 0.20±0.41 mm (p=0.455); SAC: −0.24±0.44 and −0.33±0.49 mm (p=0.511); and Ranawat value: −0.22±0.42 and −0.27±0.46 mm (p=0.698). In the DAS remission (n=32) and non-remission patients (n=20), the respective changes in cervical lesion parameters in 1 year were as follows: ADI: 0.13±0.34 and 0.55±0.61 mm (p=0.003); SAC: −0.13±0.34 and −0.50±0.51 mm (p=0.003); and Ranawat value: −0.19±0.40 and −0.30±0.47 mm (p=0.354). On the other hand in the CDAI remission (n=14) and non-remission patients (n=38), the respective changes in cervical lesion parameters in 1 year were as follows: ADI: 0 and 0.40±0.55 mm (p=0.009); SAC: 0 and −0.37±0.49 mm (p=0.009); and Ranawat value: 0 and −0.32±0.47 mm (p=0.018). In the non-progressive (ΔTSS≤0, n=18) and progressive patients (ΔTSS >0, n=34), the respective changes in cervical lesion parameters in 1 year were as follows: ADI: 0 and 0.44±0.56 mm (p=0.002); SAC: 0 and −0.41±0.50 mm (p=0.002); and Ranawat value: 0 and −0.35±0.49 mm (p=0.004).
Conclusions TCZ treatment can be used to suppress the progression of RA cervical lesions regardless of naïve or switch and with or without MTX. 1 year after initiation, the cervical lesion did not progress at all for the patients that a hand joint destruction did not progress and who achieved remission of the CDAI criteria at Week 52.
Disclosure of Interest None declared
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