IMPACT OF TOCILIZUMAB THERAPY ON STRUCTURAL JOINT DAMAGE PROGRESSION IN RHEUMATOID ARTHRITIS

Abstract

Objective — to evaluate the impact of tocilizumab (TCZ) therapy on progression of joint destruction and rheumatoid arthritis (RA) inflammatory activity in 48 weeks after initiation of treatment. Material and methods. 42 RA patients who received 6 intravenous TCZ infusions at dose 8 mg/kg given once every 4 weeks alongside with stable anti-inflammatory and glucocorticoid DMARDs were evaluated. EULAR criteria, as well as SDAI and CDAI disease activity indices were used to evaluate the efficacy of TCZ therapy. Radiographs of the hand and distal feet of each patient were obtained at baseline before initiating TCZ therapy and then at 48 weeks. Absence of radiographic progression was defined as total Sharp/van der Heijde score change ≤0. Results. At Week 48 the following values of indices — DAS28 — 4,69 [3,86; 5,44], SDAI — 17,8 [10,7; 29,5], CDAI — 17,1 [7,2; 26,2] — were corresponding to moderate disease activity and were significantly lower than the baseline values. Remission by DAS28 was observed in 11,9% patients, by SDAI — in 7,1%, and by CDAI — in 9,5%. Baseline median total Sharp/van der Heijde score equaled to 78 [46; 122], the number of erosions — to 10,5 [2; 35], and the number ofjoint space narrowing — to 67 [42; 98], while at Week 48 the values of these indices were — 80 [44; 130], 13,5 [1,5; 34] and 69,5 [38; 110], respectively, with signs of radiographic progression in 9 (22,5%) patients. There were no significant differences in the number of erosions and total Sharp scores in subgroups of patients with low, moderate or high disease activity by SDAI & CDAI and sustainable remission at Week 48. Conclusion. Clinical outcomes after 24-week TCZ therapy are indicative of its' clinical effectiveness and a potential to inhibit structural joint damage progression in RA patients.