Interleukin 6 Blockade in Spondyloarthritis: Figure 1.

Abstract

To the Editor: We read with interest the case report by Cohen, et al on sustained clinical improvement under tocilizumab [a humanized monoclonal antiinterleukin 6 (IL-6) receptor antibody] in a patient with HLA-B27-positive ankylosing spondylitis (AS)1. The patient had not responded after 3 anti-tumor necrosis factor (TNF-α) agents. There are still few but promising reports of successful treatment of spondyloarthritis (SpA) with tocilizumab. Here we add our experience. A 61-year-old woman had a 19-year history of HLA-B27-positive AS. At onset, radiographic imaging showed multilevel spondylodiscitis with acquired vertebral blocks and grade IV bilateral sacroiliitis. Due to insufficient response to nonsteroidal antiinflammatory drugs, she was prescribed etanercept from 2003 to 2010. In 2010, etanercept was switched to adalimumab because of multiple side effects including recurrent urinary tract infections, rhinosinusitis, furunculosis, and patient-reported shortness of breath after etanercept injections. Despite its efficacy on axial symptoms, adalimumab was withdrawn after 8 months because of the recurrence of infectious episodes including herpes zoster, rhinosinusitis, persistent furunculosis, and a dengue virus after traveling to the West … Address correspondence to Dr. Y. Allanore, Service de Rhumatologie A, Hopital Cochin, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France. E-mail: yannick.allanore{at}cch.aphp.fr