Comparison of the clinical utility of tocilizumab and anti-TNF therapy in AA amyloidosis complicating rheumatic diseases
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ORIGINAL ARTICLE
Comparison of the clinical utility of tocilizumab and anti-TNF therapy in AA amyloidosis complicating rheumatic diseases Yasuaki Okuda • Makoto Ohnishi • Kenichiro Matoba Kazuo Jouyama • Akihiro Yamada • Naoya Sawada • Sho Mokuda • Yousuke Murata • Kiyoshi Takasugi
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Received: 19 November 2012 / Accepted: 29 January 2013 Ó Japan College of Rheumatology 2013
Abstract Objectives Anti-cytokine therapy is reportedly useful in amyloid A (AA) amyloidosis complicating rheumatic diseases. However, to date no studies have directly compared the utility of tumour necrosis factor (TNF) inhibition to that of interleukin-6. The aim of our retrospective study was to compare the clinical utility of tocilizumab (TCZ) and antiTNF (TNF inhibitor) therapy. Methods We studied 42 patients treated with anti-cytokine agents at our hospital: 31 had received a single agent, ten had received two agents and one had received three agents. Patients were divided into a TCZ group (22 patients) and a TNF inhibitor group (32 patients). The main parameters compared were treatment retention rate, serum amyloid A (SAA) profile, renal function profile and clinical disease activity index. Results The 5-year retention rates were 90.4 (TCZ group) and 34.3 % (TNF inhibitor group) (p = 0.0154, log-rank test). The median SAA fell from 219.2 lg/mL at treatment initiation to 5.0 lg/mL at last observation (TCZ), and from 143.6 to 38.1 lg/mL (TNF inhibitor) (p = 0.0194). Estimated glomerular filtration rate was improved in 72.7 (TCZ) and 34.4 % (TNF inhibitor) of patients (p = 0.0062). The rates of clinical remission or low disease activity at last observation for the TCZ and TNF inhibitor groups were 72.7 and 40.7 % (p = 0.0201), respectively.
Y. Okuda (&) M. Ohnishi K. Matoba K. Jouyama A. Yamada N. Sawada S. Mokuda Y. Murata K. Takasugi Department of Internal Medicine, Center for Rheumatic Diseases, Dohgo Spa Hospital, 21-21 Otsu Dohgo-Himezuka, Matsuyama, Ehime 790-0858, Japan e-mail: [email protected]
Conclusions Based on these results, we conclude that TCZ was of greater clinical utility than anti-TNF therapy in our patients with AA amyloidosis complicating rheumatic diseases. Keywords AA amyloidosis Tocilizumab Anti-TNF therapy RA SAA
Introduction Amyloid A (AA) amyloidosis resulting from the deposition of AA protein in the extracellular matrices of various target organs may lead to multiple organ dysfunction. The prognosis is usually poor in patients with advanced stage AA amyloidosis. AA amyloidosis commonly affects the kidney and the gastrointestinal tract, and it is characterised by various clinical symptoms, such as progressive proteinuria and renal dysfunction and failure. Control of the underlying disease, i.e. suppression of serum amyloid A (SAA) levels, is the most critical step in the treatment of AA amyloidosis [1, 2]. Some retrospective studies and case reports have shown anti-tumour necrosis factor (TNF) therapies to be useful against AA amyloidosis [3–7]. Although treatment with anti-TNF
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