Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


A Decrease in Neutrophil Counts Following a Single Infusion of Tocilizumab Is Predictive of Low Disease Activity and Remission after 24 Weeks.

Saech2,  Jasemine, Kuhr1,  Kathrin, Laudes1,  Matthias, Schultz1,  Olaf, Rath1,  Thomas, Roehrs1,  Tobias, Rubbert-Roth1,  Andrea

University Clinic Cologne
University Clinic of Cologne, Cologne

Background:

Tocilizumab, a humanised monoclonal antibody targeting the IL-6 receptor, represents a potent new therapeutic principle for patients with active RA and intolerance or inadequate response to conventional DMARDs and/or TNF-blockers. Given the broad therapeutic armentarium of biologics that is available for RA patients today, predictive parameters before or during the early treatment period are urgently needed to optimize therapeutic strategies.

Method:

In our center, 40 patients with active RA were started on tocilizumab 8 mg/kg iv q4w and followed prospectively for 24 weeks. DAS 28 and routine laboratory parameters were obtained at baseline and every 4 weeks subsequently.

Results:

40 patients (25% male, 75% female, mean baseline DAS28 6.09) were treated with tocilizumab 8mg/kg. 15/40 (42%) patients received tocilizumab as monotherapy and 25/40 (58%) with concomitant DMARD treatment. In 26/40 (64%) patients, tocilizumab was used as the first biological.

After 24 weeks, 20 patients achieved low disease activity LDA (DAS 28<=3.2) and 12 were in remission (DAS28<=2,6). CRP, neutrophils or other clinical or laboratory parameters at baseline did not correlate to outcome at week 24.

Patients with a DAS decrease of >= 1.2 at week 4 (early responders = ER) were compared to patients with a DAS difference of < 1.2 at week 4 (early non-responders = NR). 64 % of the ER, but only 31% of NR achieved LDA in week 24 (n.s.). More impressively, 52% of the ER, but 11% of the NR achieved remission in week 24 (p=0.02).

CRP levels normalized in all patients at week 4 and did not differ bet-ween ER and NR. Neutrophil counts at week 4 remained within normal limits in all patients. Of note, a decrease in neutrophil counts of >=25% from baseline to week 4 was observed more frequently in ER (20/31) than in NR (2/9) (p = 0.05). More interestingly, a neutrophil decrease of >=25% from baseline to week 4 was significantly associated with LDA and remission at week 24 (p=0,03).

Conclusion:

Patients who responded to tocilizumab with a DAS 28 decrease of >=1.2 in week 4 (ER) achieved remission significantly more often in week 24 than patients who do not respond ar week 4. Baseline CRP or normalization of CRP at week 4 did not correlate to ER/NR at week 4 or to LDA/re-mission at week 24. Of note, a decrease in neutrophil counts of >=25% after a single infusion of tocilizumab (baseline to week 4) was highly predictive for achieving LDA/remission in week 24.

To cite this abstract, please use the following information:
Saech, Jasemine, Kuhr, Kathrin, Laudes, Matthias, Schultz, Olaf, Rath, Thomas, Roehrs, Tobias, et al; A Decrease in Neutrophil Counts Following a Single Infusion of Tocilizumab Is Predictive of Low Disease Activity and Remission after 24 Weeks. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :294
DOI: 10.1002/art.28063

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