SAT0235 Bone Mineral Density under Tolicizumab Therapy – Results of A Prospective 5-Year Analysis
Authors: M. Höhle, R. Maas
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> The IL6-antibody tolicizumab (TCZ) leads to a rapid improvement of the clinical course in patients with rheumatoid arthritis (RA) as assessed by the DAS28 score.4 However, in MR and ultrasound imaging a residual activity of the rheumatic process can still be detected.2 RA is a known risk factor for the occurence of bone fractures related to osteoporosis.3 TCZ has a positive effect on bone remodeling1 and might be useful to prevent RA related bone fractures. <h3>Objectives</h3> The purpose of this analysis was to investigate the effect of TCZ on bone remodeling in patients with severe RA. <h3>Methods</h3> 50 patients with RA treated with TCZ as monotherapy since 2008 were prospectively analyzed. Ultrasound was performed and the DAS28 was determined at baseline and every 4 weeks thereafter. Lab parameters investigating bone metabolism, protein diagnostics and MRI were performed at baseline and every 6 months thereafter. Once a year patients underwent CT and DXA scan. <h3>Results</h3> In all 50 patients (age 20-72 years, 33 female), the DAS28 score normalized at the latest by the 3rd infusion cycle. An initial MRI RAMSIS score &gt;5 was reduced to ≤2 after 6 to 18 months. The ultrasound score for synovialitis declined after 8 weeks and after 12 months for tenosynovialitis. At baseline in 22 women with early RA, axial QCT/DXA values and lateral DXA values within the reference range were documented. 3 patients with early RA had osteopenia, 2 has osteoporosis. 1 patient 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 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. Vitamine D3 was substituted in these patients. 2 patients with osteoporosis were treated with bisphosphonates. In all patients, BMD values were within the reference range after 1 year of treatment with TCZ. <h3>Conclusions</h3> 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. 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. <h3>References</h3> Briot K et al.; Positive Effects of Tocilizumab On Bone Remodeling in Patients with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2012;64 Suppl 10:823 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 Specker C et al.; Tocilizumab in Rheumatoid Arthritis – One Year Interim Analysis of the Non-interventional ICHIBAN Study. Ann Rheum Dis 2012;71(Suppl3):667 <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.5844