Background Tocilizumab (TCZ) leads to a rapid improvement of the clinical course in patients with highly active rheumatoid arthritis (RA). However, a residual rheumatic activity can still be detected.1 RA is a known risk factor for osteoporosis related bone fractures.2 It is well established that TCZ has beneficial effects on bone remodeling.3
Objectives The aim of this analysis was to investigate the effects of TCZ on bone mineral density in a real world patient population.
Methods 50 rheumatoid factor positive patients with RA (17 male, age 20–72 years) who received TCZ as monotherapy since 2008 were prospectively investigated. At baseline and the following 4–6 clinical visits, DAS28 was determined and ultrasound performed. At baseline and every 6 months thereafter, biochemical parameters for bone metabolism and protein diagnostics were recorded. Once a year, the subjects underwent MRI, CT and DXA scan.
Results In all 50 patients the DAS28 normalized at the latest by the 3rd infusion cycle of TCZ. The initial RAMRIS score of >5 was reduced to <2 after 6–18 months. Ultrasound revealed a decline of synovialitis and tenodynovialitis after 8 weeks and 12 months, respectively. At baseline in 22 women with early RA, axial QCT/DXA values and lateral DXA values were within reference. 3 patients with early RA had osteopenia, 2 had osteoporosis. Patients 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 manifest 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 and were treated with vitamin D3. 2 patients with osteoporosis were treated with antiresorptive medication. In all patients, BMD values were within the reference range after 1 year of treatment with TCZ, despite 18% of patients presenting with a DAS score >2.7. 2 patients presented with pustular dermatosis in the palms. No allergic reactions were observed.
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 and therefore BMD. 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. Temporary elevations of DAS28 during TCZ therapy do not negatively affect BMD.
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
Briot K et al.; Positive Effects of Tocilizumab On Bone Remodeling in Patients with
Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2012;64 Suppl 10:823
Disclosure of Interest None declared