Background Rheumatoid Arthritis (RA) is a systemic, inflammatory, chronic, autoimmune disease that predominantly affects the joints.1 In the last decade new drugs have been introduced, including biological drugs that act on different targets implicated in the pathogenesis of the disease.2 Within this group of drugs is tocilizumab (TCZ), a humanized monoclonal antibody anti IL-6r, key cytokine involved in the pathogenesis of RA and the disease activity.3 TCZ use has been associated with abnormalities in transaminases (AST, ALT).2
Objectives To determine the frequency of transaminases abnormalities in patients with RA treated with TCZ in Santo Domingo, Dominican Republic.
Methods We performed a longitudinal, observational, prospective study. The records of patients diagnosed with RA who fulfilled the 1987 ACR criteria and ACR/EULAR 2010, which use biological therapy with TCZ in HDPB and HFMP in July 2013 until August 2014 were reviewed. All patients signed informed consent. We reviewed a total of 56 records from which we selected patients who had at least 2 follow-up visits after the start of treatment (40 patients) taking into account the transaminases baseline values to compare changes. Visits were conducted every three months, mild and moderate levels were considered between (>1xUI/L, >2xUI/L) and severe (>3xUI/L) over the normal value. The patients whose records were found incomplete during the first 3 visits were excluded. The frequency of continuous variables was analyzed using the SPSS statistical program (V20.x86).
Results Of 40 patients who met the inclusion criteria, 45% (18) elevated transaminases levels. For AST elevations 33.3% (6) elevated from mild to moderate, only 5.6% (1) severely and 61.1% (11) did not alter the levels. As for ALT, 50% (9) presented increased mild to moderate, 5.6% (1) course with severe elevation and the remaining 44.4% (8) did not alter the normal parameters. On the third visit 50% (9) presented elevated AST from mild to moderate, not severe elevations were reported and 50% (9) remained within normal parameters. Elevations of ALT were higher during the third visit in 72.2% (13) of mild to moderate, only 5.6% (1) course with severe elevation and 22.2% (4) was found within normal values. Of the 18 patients who were enrolled with alterations, 83.33% (15) were using simultaneously therapy with sDMARD.
Conclusions The results of monitoring of a population of Dominican Republic showed that treatment with TCZ was associated with increased levels of transaminases.
Ann Rheum Dis 2014; 73:1607-1615.
Ann Rheum Dis 2010; 69:88-96.
Reumatol Clin.2011, 6 (S3). S29-S32.
Disclosure of Interest None declared