FRI0093 IMPACT OF INTERLEUKIN 6 RECEPTOR INHIBITOR ON N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Helen Gerasimova, Tatiana Popkova, Maria Cherkasova, Diana Novikova, Galina Lukina, Satenik Davidian
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> <h3>Objectives:</h3> To investigate the impact of interleukin 6 receptor inhibitor - tocilizumab (TCZ) on NT-proBNP level changes in patients with rheumatoid arthritis (RA) during a 12- month (m) follow-up period. <h3>Methods:</h3> The investigation enrolled 31 patients (pts) (26women/5men) with the lack of efficacy/resistance and/or intolerance of basic anti-inflammatory drugs (DMARDs); median age was 54[45; 61] years, median disease duration 10[62;168]m; DAS28 6,2[5,1;7,1]; SDAI 35,0[23,9;51,0], CDAI 30,0[21,0;42,0], serum positivity for rheumatoid factor (RF)(100%)/anti-cyclic citrullinated peptide antibodies (ACCP)(84%). The study did not include RA pts with congestive heart failure. High incidence of traditional risk factors was found in RA pts: arterial hypertension - in 75%, dyslipidemia - 61%, smoking - 17%, overweight - 61%, family history of cardiovascular diseases - 36%, hypodynamia - 68%. Coronary artery disease was diagnosed in 11% RA pts. Lack of efficacy of 3 or more DMARDs was found in 46% of pts, intolerance to previous therapy with DMARDs - in 54% pts. These patients were administered TCZ(8mg/kg) every 4 weeks: 39% were receiving TCZ monotherapy, and 61% - TCZ in combination with methotrexate (20[18;25]mg/week). Serum levels of of NT-proBNP were measured using electrochemiluminescence method Elecsys proBNP II (Roche Diagnostics, Switzerland). <h3>Results:</h3> Significant positive changes in major disease activity clinical and laboratory parameters were found in RA pts after 12 m of TCZ infusion: 54% of pts achieved remission (DAS28&lt;2,6) and 46% of pts managed to decrease activity to low level (DAS28&lt;3,2) with accompanying improvement in DAS28, levels of ESR, C-reactive protein (CRP), and RF (table 1). TCZ therapy resulted in decrease of median NT-proBNP levels from 75,8 [43,0;100,7] to 37,8[25,1;78,5] pg/ml (p=0,01), while rate of elevated (≥100pg/ml) NT-proBNP levels did not change (13%). ΔNT-proBNP correlations of with ΔESR (R=0,43; p&lt;0,05] and with ΔCRB (R=0,46; p&lt;0,05] were documented after 12m of TCZ therapy. No direct correlation between ΔNT-proBNP and changes in disease activity, or RF, or ACCP has been established. There was no noticeable differences in NT-proBNP levels in RA pts receiving TCZ monotherapy and TCZ in combination with methotrexate. <h3>Conclusion:</h3> Obtained preliminary results show that 12m of TCZ therapy resulted in decreased RA activity and lower levels of NT-proBNP on both regimens – mono - or combination (TCZ+ MT) therapy. Lowering NT-proBNP concentrations are associated with positive dynamics of inflammatory markers (CRP, ESR), therefore allowing to suggest increased NT-proBNP levels should be considered as a component of disease activity. <h3> Disclosure of Interests:</h3> Helen Gerasimova: None declared, Tatiana Popkova: None declared, Maria Cherkasova: None declared, Diana Novikova: None declared, Galina Lukina: None declared, Satenik Davidian Speakers bureau: Educational meetings organized or supported by companies.