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, anti-tumor necrosis factor antibodies for suppressing the radiographic progression of RA cervical lesions at ACR2009, EULAR2010, 11, 12, 13, 14 and 16. 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 MTX for 2 years.
Methods We used TCZ or MTX for treating Japanese patients with active RA who fulfilled the ACR criteria in 1987. The final study cohort of each 38 and 71 patients received continuous TCZ and MTX treatment for at least 2 years. 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=38) and MTX (n=71), the number of female were each 28 (72%) and 51 (72%) cases (p=0.999). The mean age was 57.3±12.4 and 63.3±10.9 years old (p=0.011); disease duration was 7.0±7.3 and 8.8±9.7 years (p=0.929) and the mean dose of MTX was 9.0±3.4 and 8.3±2.9 mg/w (p=0.335). Clinical findings related to RA were as follows; CRP 3.8±3.1 and 1.5±2.1 mg/dl (p<0.001); ESR 52.7±25.3 and 30.0±20.8mm/h (p<0.001); MMP3 400±300 and 213±356ng/ml (p<0.001); the number of RF-positive 30 (79%) and 58 (82%) cases (p=0.801); DAS28-ESR 5.46±0.92 and 4.24±1.34 (p<0.001); ADI 2.7±1.7 and 2.6±1.6mm (p=0.917); SAC 19.3±2.8 and 20.7±2.5mm (p=0.008) and Ranawat value 15.4±1.6 and 15.9±1.5mm (p=0.073). The respective changes in cervical lesion parameters after 1 year were as follows: ADI: 0.21±0.53 and 0.25±0.44 mm (p=0.327); SAC: −0.16±0.44 and −0.17±0.38 mm (p=0.653); and Ranawat value: −0.13±0.34 and −0.11±0.32 mm (p=0.773). The respective changes in cervical lesion parameters after 2 years were as follows: ADI: 0.32±0.70 and 0.52±0.67 mm (p=0.045); SAC: −0.24±0.49 and −0.45±0.63 mm (p=0.067); and Ranawat value: −0.24±0.49 and −0.35±0.56 mm (p=0.270) in the patients receiving TCZ and MTX (Fig.1). The numbers of patients who did not showed progression in ADI, SAC and Ranawat value were each 30 (79%) and 41 (58%) cases (p=0.035); 30 (79%) and 44 (62%) cases (p=0.087) and 30 (79%) and 49 (69%) cases (p=0.367) after 2 years. Also the number who was able to suppress progression in all three parameters were each 29 cases (76%) receiving TCZ and 41 cases (58%) receiving MTX (p=0.062) after 2 years (Fig.2).
Conclusions This study suggested that TCZ treatment can be used to suppress the progression of RA cervical lesions more than MTX treatment.
Disclosure of Interest None declared