Is IL-6 an appropriate target to treat spondyloarthritis patients refractory to anti-TNF therapy? a multicentre retrospective observational study

Abstract

IntroductionThe aim of this study was to evaluate, under real-life conditions, the safety and efficacy of tocilizumab in patients having failed anti-TNFα therapy for spondyloarthritis.MethodsFrench rheumatologists and internal-medicine practitioners registered on the Club Rhumatismes et Inflammations website were asked to report on patients given tocilizumab (4 or 8 mg/kg) to treat active disease meeting Assessment of SpondyloArthritis International Society (ASAS) criteria for axial or peripheral spondyloarthritis, after anti-TNFα treatment failure. Safety and efficacy after 3 and 6 months were assessed retrospectively using standardised questionnaires.ResultsData were obtained for 21 patients, 13 with axial spondyloarthritis (46% men; median age, 42 years; disease duration, 11 years; HLA-B27-positive, 92.3%) and eight with peripheral spondyloarthritis (25% men; median age, 40 years; disease duration, 10 years; HLA-B27-positive, 62.5%). No patients with axial disease had at least a 20 mm decrease in the BASDAI, nor a BASDAI50 response or major ASAS-endorsed disease activity score improvements after 3 or 6 months; an ASAS-endorsed disease activity score clinically important improvement was noted at month 3 in five of 13 patients and at month 6 in one of four patients. A good DAS28 response was achieved in four patients with peripheral disease, including one in EULAR remission at month 3. Four patients were still taking tocilizumab at month 6, including one in EULAR remission and one with a good DAS28 response. Tocilizumab was well tolerated, with no serious adverse events. Initially elevated acute-phase reactants declined during tocilizumab therapy.ConclusionIn patients having failed anti-TNFα therapy, tocilizumab decreased acute-phase reactants but failed to substantially improve axial spondyloarthritis and was inconsistently effective in peripheral spondyloarthritis.

IL-17 in the Rheumatologist’s Line of Sight

“…While IL-6 targeting is showing efficiency in RA, tolicizumab therapy has been disappointing in SpA patients [214, 215]. …”

Treatment of spondyloarthropathy

“…In a phase II, multicenter, randomized, double-blind, placebo-controlled study [25 && ] of tocilizumab for 102 patients with AS, no clinical efficacy was observed, although there was significant CRP reduction in the tocilizumab treatment group. In a multicenter retrospective observational study [27], the efficacy of tocilizumab in 21 patients with SpA who failed in TNF-a blocker was evaluated. In a multicenter retrospective observational study [27], the efficacy of tocilizumab in 21 patients with SpA who failed in TNF-a blocker was evaluated.…”

Pharmacological treatment of spondyloarthritis: exploring the effectiveness of nonsteroidal anti-inflammatory drugs, traditional disease-modifying antirheumatic drugs and biological therapies

“…TOC is emerging as a potential therapeutic strategy in other rheumatic disorders for its IL-6-mediated effects on immune system and inflammatory processes [Woodrick and Ruderman, 2012;Abisror et al 2013]. However, TOC did not show any clinical improvement in patients with axial SpA [Lekpa et al 2012b].…”