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AB0487 Efficacy of Tocilizumab for Suppressing Radiographic Progression of Cervical Lesions in Patients with Rheumatoid Arthritis Comparison with Infliximab; Two Years of Follow-Up – a Multicenter Registry Study
  1. Y. Kanayama1,
  2. T. Kojima2,
  3. Y. Hirano3,
  4. Y. Yabe4,
  5. N. Takahashi2,
  6. S. Hirabara3,
  7. N. Ishiguro2
  8. on behalf of Tsurumai Biologics Communication Registry (TBCR)
  1. 1Orthopedic Surgery And Rheumatology, Toyota Kosei Hospital, Toyota
  2. 2Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya
  3. 3Rheumatology, Toyohashi Municipal Hospital, Toyohashi
  4. 4Rheumatology, JCHO Tokyo-Shinjyuku Medical Center, Tokyo, Japan

Abstract

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 suppressing the radiographic progression of RA cervical lesions at ACR2009, EULAR2010, 11, 12, 13 and 14. However there is still few 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 comparison with IFX for 2 years.

Methods We used TCZ and IFX for treating each 270 and 604 Japanese patients with active RA who fulfilled the ACR criteria in 1987 from Tsurumai Biologics Communication Registry (TBCR). The final study cohort of each 21 and 88 patients received continuous TCZ and IFX treatment for at least 2 years. The TCZ dose was 8 mg/kg. The later doses were administered every 4 weeks up. 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 Year 1,2.

Results In the patients receiving TCZ (n=21) and IFX (n=88), the number of female were each 14 (67%) and 75 (85%) cases (p=0.062). The mean age was 58.3±10.6 and 53.9±12.9 years old (p=0.289); disease duration was 7.3±6.9 and 10.7±9.2 years (p=0.125); the number of biologics naïve patient were 4 (19%) and 85 (97%) cases (p<0.001) and the number of receiving methotrexate (MTX) was 16 (76%) and 88 (100%) cases (p<0.001). Clinical findings related to RA were as follows; CRP 4.2±3.1 and 3.1±2.8 mg/dl (p=0.073); ESR 56.0±27.0 and 49.9±29.1mm/h (p=0.367); MMP3 476±347 and 337±309ng/ml (p=0.049); DAS28 5.59±0.74 and 5.47±1.25 (p=0.642); ADI 2.8±1.8 and 3.6±1.9mm (p=0.031); SAC 19.3±2.9 and 18.1±2.7mm (p=0.060) and Ranawat value 15.0±1.7 and 14.5±2.2mm (p=0.518). The respective changes in cervical lesion parameters after 1 year were as follows: ADI: 0.19±0.51and 0.22±0.44 mm (p=0.579); SAC: −0.19±0.40 and −0.16±0.40 mm (p=0.647); and Ranawat value: −0.14±0.36 and −0.15±0.36 mm (p=0.955). The respective changes in cervical lesion parameters after 2 years were as follows: ADI: 0.29±0.56 and 0.35±0.59 mm (p=0.609); SAC: −0.24±0.44 and −0.27±0.60 mm (p=0.958); and Ranawat value: −0.24±0.44 and −0.26±0.47 mm (p=0.890). The numbers of patients who did not showed progression in ADI, SAC, Ranewat value and all three parameters were each 16 (76%) and 62 (70%) cases (p=0.789); 16 (76%) and 68 (77%) cases (p=0.910) and 16 (76%) and 66 (75%) cases (p=0.910) after 2 years. Also the number who was able to suppress progression in all three parameters were each 15 cases (71%) receiving TCZ and 58 cases (66%) receiving IFX (p=0.797).

Conclusions This study suggested that TCZ treatment can be used to suppress the progression of RA cervical lesions as well as IFX treatment.

Disclosure of Interest Y. Kanayama: None declared, T. Kojima Speakers bureau: Abbott Japan Co. Ltd.; Eisai Co. Ltd.; Mitsubishi Tanabe Pharma Corporation; Pfizer Co. Ltd.; Chugai Pharmaceutical Co. Ltd.; and Bristol-Myers Squibb Co. Ltd., Y. Hirano Speakers bureau: Abbott Japan Co. Ltd.; Eisai Co. Ltd.; Mitsubishi Tanabe Pharma Corporation; Pfizer Co. Ltd.; Chugai Pharmaceutical Co. Ltd.; and Bristol-Myers Squibb Co. Ltd., Y. Yabe: None declared, N. Takahashi Speakers bureau: Abbott Japan Co. Ltd.; Eisai Co. Ltd.; Mitsubishi Tanabe Pharma Corporation; Pfizer Co. Ltd.; Chugai Pharmaceutical Co. Ltd.; and Bristol-Myers Squibb Co. Ltd., S. Hirabara: None declared, N. Ishiguro Speakers bureau: Abbott Japan Co. Ltd.; Eisai Co. Ltd.; Mitsubishi Tanabe Pharma Corporation; Pfizer Co. Ltd.; Chugai Pharmaceutical Co. Ltd.; and Bristol-Myers Squibb Co. Ltd.

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