Rheumatoid arthritis: tocilizumab tops TNF inhibition for bone erosion repair

  • Finzel S & al.
  • Ann Rheum Dis
  • 29 May 2019

  • International Clinical Digest
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Takeaway

  • Tocilizumab surpassed adalimumab (ADA)+methotrexate (MTX) in repair of bone erosion in patients with active erosive rheumatoid arthritis (RA) with inadequate response to MTX alone.
  • Repair of bone erosion by tocilizumab was associated with increased biomarkers of bone formation.

Why this matters

  • Bone erosion in RA should not be construed as irreversible.
  • Results suggest that IL-6 inhibition with tocilizumab is preferential to TNF inhibition with ADA for bone erosion repair.

Study design

  • Prospective cohort of patients treated with tocilizumab (n=33) or ADA+MTX (n=33).
  • Clinical response was assessed every 3 months over the course of 52 weeks with Clinical Disease Activity Index (CDAI), Simple Disease Activity Index (SDAI), Disease Activity Score 28-Erythrocyte Sedimentation Rate (DAS28-ESR), and Heath Assessment Questionnaire Disability Index (HAQ-DI), among others.
  • Bone erosion repair was assayed by erosion volume on high-resolution peripheral quantitative CT (HR-pQCT) and bone biomarkers, including osteocalcin.
  • Funding: Chugai.

Key results

  • No differences between groups on clinical activity, with both groups improving on CDAI, SDAI, DAS28-ESR, and HAQ-DI, among others.
  • Tocilizumab was associated with greater decline in erosion volumes vs ADA/MTX at the metacarpal head 2 site (P<.0001 and at the radius by hr-pqct.>
  • Tocilizumab was associated with increased osteocalcin levels, but no difference in bone resorption biomarkers.

Limitations

  • Small sample sizes.
  • Observational design.