SAT0150 EFFICACY OF TOCILIZUMAB FOR SUPPRESSING RADIOGRAPHIC PROGRESSION OF CERVICAL LESIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS COMPARISON WITH METHOTREXATE; THREE YEARS OF FOLLOW-UP ∼A MULTICENTER REGISTRY STUDY ∼
Authors: Yasuhide Kanayama, Toshihisa Kojima, Yuji Hirano, Yuichiro Yabe, Nobunori Takahashi, Naoki Ishiguro
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Cervical lesions are known to occur at high frequency as a complication of rheumatoid arthritis (RA). Treatment with biological agents are more clinically effective than the DMARDs that were in use previously, in particular, with their efficacy in suppressing joint destruction having been emphasized. We reported the efficacy of infliximab, anti-tumor necrosis factor antibodies for suppressing the radiographic progression of RA cervical lesions at ACR2009, EULAR2010, 11, 12, 13, 14, 16 and 18. However there is still few studies of efficacy of against RA cervical lesions of Tocilizumab (TCZ), anti-interleukin 6 receptor antibody. <h3>Objectives:</h3> To evaluate the efficacy of TCZ for suppressing the radiographic progression of RA cervical lesions comparison with MTX for 3 years. <h3>Methods:</h3> We used TCZ or MTX for treating Japanese patients with active RA who fulfilled the ACR criteria in 1987. The final study cohort of each 50 and 75 patients received continuous TCZ and MTX treatment for at least 3 years. For evaluation of cervical lesions, the atlanto-dental interval (ADI), the space available for the spinal cord (SAC), and the Ranawat value were measured by plain lateral radiographs in the flexion position, at initiation and Year 1,2 and 3. <h3>Results:</h3> In the patients receiving TCZ (n=50) and MTX (n =75), the number of female were each 38(76%) and 52(69%) cases(p=0.416). The mean age was 58.7 ± 13.0 and 63.6 ± 11.0 years old (p=0.046); disease duration was 7.7 ± 7.8 and 8.0 ± 9.5 years (p=0.247) and the mean dose of MTX was 9.2 ± 3.6 and 8.2 ± 2.9 mg/w (p=0.146). Clinical findings related to RA were as follows; CRP 4.2± 3.4 and 1.7± 2.3 mg/dl(p&lt;0.001); ESR 55.0± 24.0 and 31.9 ± 21.8mm/h(p&lt;0.001); MMP3 401 ± 311 and 223 ± 350ng/ml(p&lt;0.001); the number of RF-positive 40(80%) and 60(80%) cases(p=0.999); DAS28-ESR 5.45 ± 0.98 and 4.30 ± 1.38 (p&lt;0.001); ADI 2.9 ± 1.7 and 2.6 ± 1.6mm(p=0.335); SAC 18.9 ± 2.7 and 20.8 ± 2.5mm(p&lt;0.001) and Ranawat value 15.2 ± 1.6 and 16.0 ± 1.5mm (p=0.008). The respective changes in cervical lesion parameters after 3 years were as follows: ADI: 0.46 ± 0.79 and 0.71 ± 0.80 mm (p = 0.044); SAC: −0.34 ± 0.63 and −0.63 ± 0.82 mm (p = 0.027); and Ranawat value: −0.32 ± 0.59 and −0.44 ± 0.66 mm (p = 0.295) between TCZ and MTX patients (Fig.1). The numbers of patients who did not showed progression in ADI, SAC and Ranawat value were each 34(68%) vs 37(49%) cases(p=0.039); 37(74%) vs 40(53%) cases(p=0.020) and 37(74%) vs 49(65%) cases(p=0.306) after 3 years. Also the number who was able to suppress progression in all three parameters were each 34 cases (68%) receiving TCZ and 37 cases (49%) receiving MTX (p=0.039) after 3 years (Fig.2). <h3>Conclusion:</h3> This study suggested that TCZ treatment can be used to suppress the progression of RA cervical lesions more than MTX treatment. <h3>Disclosure of Interests:</h3> Yasuhide Kanayama: None declared, Toshihisa Kojima Grant/research support from: Chugai Pharmaceutical (Investigator Initiated Study), Novartis, Nippon Kayaku, Eli Lilly, Eisai, Speakers bureau: Chugai Pharmaceutical, Takeda Pharmaceutical, Pfizer, Eli Lilly Japan, Bristol Myers Squibb, Ono Pharmaceutical, Daiichi Sankyo, Astelas, UCB, Janssen Pharmaceutical, Tanabe Mitsubishi, Yuji Hirano: None declared, Yuichiro Yabe: None declared, Nobunori Takahashi Speakers bureau: AbbVie, Bristol-Myers Squibb, Chugai, Eisai, Mitsubishi Tanabe, and Pfizer. YS has received speakers’ fees from Astellas, Bristol-Myers Squibb, and Ono, Naoki Ishiguro Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi-Sankyo, Eisai, Kaken, Mitsubishi Tanabe, Otsuka, Pfizer, Takeda, and Zimmer Biomet, Consultant for: Ono, Speakers bureau: Astellas, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Pfizer, and Taisho Toyama