Open Access Research article

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

Fernando Kemta Lekpa1, Cécile Poulain1, Daniel Wendling2, Martin Soubrier3, Michel De Bandt4, Jean Marie Berthelot5, Philippe Gaudin6, Eric Toussirot27, Philippe Goupille8, Thao Pham9, Jérémie Sellam10, Rémy Bruckert11, Muriel Paul12, Valérie Farrenq1, Pascal Claudepierre113* and the Club Rhumatismes et Inflammation

Author affiliations

1 Rheumatology Department, AP-HP, Henri Mondor University Hospital, 51 avenue du Mal de Lattre de Tassigny, 94010 Créteil, France

2 Rheumatology Department, Jean Minjoz University Hospital, 2 boulevard Fleming, 25030 Besançon, France

3 Rheumatology Department, Gabriel Montpied University Hospital, 58 rue Montalembert, 63000 Clermont-Ferrand, France

4 Rheumatology Department, Robert Ballanger Hospital, boulevard Robert Ballanger, 93602 Aulnay sous Bois, France

5 Rheumatology Department, Hôtel Dieu University Hospital, place Alexis Ricordeau, 44093 Nantes, France

6 Rheumatology Department, University Hospital, Grenoble, Hôpital Sud, 19 avenue de Kimberley BP 185, 38130 Echirolles, France

7 CIC-Biotherapy 506, St Jacques Hospital University Hospital, 2 boulevard Fleming, 25030 Besançon France

8 Rheumatology Department, Trousseau University Hospital, 37044 Tours Cedex 1, France

9 Rheumatology Department, Conception University Hospital, 147 boulevard Baille, 13385 Marseille, France

10 Rheumatology Department, Saint-Antoine Hospital, Pierre et Marie Curie University, 184 rue du faubourg Saint Antoie, 75012 Paris, France

11 INSERM Unit 955, AP-HP, Henri Mondor University Hospital, 51 avenue du Mal de Lattre de Tassigny, 94010 Créteil, France

12 Pharmacy Department, AP-HP, Henri Mondor University Hospital, 51 avenue du Mal de Lattre de Tassigny, 94010 Créteil, France

13 LIC EA4393, University Paris Est, 8 avenue du Général Sarrail, 94000 Créteil, France

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Citation and License

Arthritis Research & Therapy 2012, 14:R53  doi:10.1186/ar3766

Published: 9 March 2012

Abstract

Introduction

The 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.

Methods

French 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.

Results

Data 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.

Conclusion

In 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.