Effect Of Tocilizumab Research Articles

British Cardiac Society newsletter

<h3>Background</h3> Tocilizumab (TCZ) is an anti-IL-6 agent given as second-line biotherapy in the treatment of rheumatoid arthritis (RA). Guidelines for the prescription of TCZ indicate that it must be administered after anti-TNF-α failure at the University Hospital of Montpellier (UHM). <h3>Purpose</h3> To assess the prescriptions for TCZ and cheque them against the existing guidelines since an increasing number of patients are treated at the UHM. <h3>Materials and Methods</h3> The study was conducted over a period of 20 months, from January 2010 (marketing of TCZ) to July 2011. Patients treated with TCZ were identified thanks to the hospital information database. Data collected were: indications, previous treatment, number of anti-TNF-α drugs used before TCZ, association with conventional treatment, and biotherapy implemented if TCZ fails. <h3>Results</h3> 149 patients were treated with TCZ: RA 93.4%, juvenile idiopathic arthritis 3.7%, Still’s disease and ankylosing spondylitis 2.9% (off-label). All patients had previously been treated with methotrexate (MTX). TCZ was administered after failure of anti-TNF-α in 79.2% of the cases. 13.4% received TCZ as first-line biotherapy. For 59.1% of patients, TCZ was associated with the conventional treatment. 62.6% were treated with MTX. We evaluated the effectiveness of TCZ in 88 patients (patients who had not started their treatment in clinical trials in the last 6 months of the study): the treatment was successful for 67 of them (76.1%). TCZ was not effective in 23.9% with a mean treatment duration of 7.1 months. For these patients, TCZ was switched to abatacept (anti-CTLA4) 47.6%, anti-TNF-α 33.3% or rituximab (anti-CD20) 19.1%. <h3>Conclusions</h3> TCZ is an active molecule in the treatment of RA. Our guidelines are not always respected since TCZ was used as first-line biotherapy in 13.4% of patients. Further evaluation of this early use is needed to understand the practise of the prescribers. No conflict of interest.

Starting on prevention in practice

<h3>Background</h3> Tocilizumab (TCZ) has shown efficacy in large-vessel vasculitis, including Giant Cell Arteritis (GCA) <b>(1-3</b>). Clinical trials with TCZ in GCA was performed with intravenous (iv) TCZ in a phase 2 trial <b>(3</b>), and with subcutaneous (sc) TCZ in the phase 3 GiACTA <b>(4</b>). However, in GCA there are no studies comparing IV vs SC TCZ. <h3>Objectives</h3> To compare the efficacy of TCZ in GCA patients according to the route of administration IV-TCZ vs SC-TCZ. <h3>Methods</h3> Multicentre study of 471 patients diagnosed with GCA and treated with TCZ. They were divided into 2 groups according to the route of administration: <b>a</b>) IV, and <b>b</b>) SC. GCA was diagnosed by: <b>a</b>) ACR criteria, and/or <b>b</b>) temporal artery biopsy, and/or <b>c</b>) imaging techniques. Sustained remission was established according to EULAR definitions <b>(5</b>). <h3>Results</h3> We studied 471 patients (mean age, 74±9 years) treated with TCZ, 238 with IV-TCZ and 233 with SC-TCZ (Table 1). The time between diagnosis of GCA and TCZ onset was shorter in the SC TCZ group. Regarding acute phase reactants at the beginning of TCZ, no differences were found between both groups. There were no significant differences in sustained remission or in glucocorticoid-sparing effect of TCZ (Figure 1). Patients on IV TCZ treatment suffered more relevant adverse effects during follow-up. <h3>Conclusion</h3> In GCA, TCZ seems equally effective and safe regardless of the route of administration IV or SC. <h3>References</h3> [1]Calderón-Goercke M, et al. Semin Arthritis Rheum. 2019; 49: 126-135. PMID: 30655091 [2]Prieto-Peña D, et al. Ther Adv Musculoskelet Dis. 2021; 13: 1759720X211020917. PMID: 34211589 [3]Villiger PM, et al. Lancet. 2016; 387:1921-1927. PMID: 26952547 [4]Stone JH, et al. N Engl J Med. 2017; 377:317-328. PMID: 28745999 Hellmich B, et al. Ann Rheum Dis. 2020; 79: 19-30. PMID: 31270110 <h3>Disclosure of Interests</h3> None declared