Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Tocilizumab Improves Arterial Stiffness Compared with Abatacept In Patients with TNF Blockers-Resistant Active Rheumatoid Arthritis.An Open Label Randomized Controlled Trial.

Kume1,  Kensuke, Amano1,  Kanzo, Yamada1,  Susumu, Hatta2,  Kazuhiko

Hiroshima Clinic, Hiroshima, Japan
Hatta Clinic, Kure, Japan

Background/Purpose:

Rheumatologists need to develop primary prevention strategies for cardiovascular disease(CVD) in rheumatoid arthritis (RA) patients.To compare the effect of tocilizumab(TCZ) plus methotrexate (MTX), with the effect of abatacept(ABT) plus MTX on arterial stiffness in TNF blockers resistant active RA patients, in a open label randomized study design.

Methods:

RA patients were eligible if they had active disease despite treatment with MTX plus TNF blockers. All patients have no steroids, and no previous history of CVD. 32 patients with moderate to severe active RA patients (DAS28 >3.2) were randomly assigned to receive TCZ plus MTX (n=16) or ABT plus MTX (n=16). All patients with worsening disease activity at week 12, the patients were allowed to escape to another group (by clinician's judgment).Arterial stiffness was assessed with cardio-ankle vascular index (CAVI) and augmentation index corrected for a heart rate of 75 beats per minute (AIx@75) at baseline and 24 weeks follow-up. Cardiovascular risk factors and clinical data was collected at regular visits.CAVI was calculated by the following formula:CAVI= 2r/dP×ln(Ps/Pd)PWV2, where Ps is systolic blood pressure, Pd is diastolic blood pressure, PWV is pulse wave velocity, dP is Ps– Pd,r is blood density.CAVI measures arterial wall stiffness independent of blood pressure and it is superior to PWV as an index of arterial stiffness.

Results:

The characteristics of each group at baseline were not significantly different. 15 each in the TCZ and ABT groups completed 24 weeks.CAVI and AIx@75 were attenuated significantly by TCZ (CAVI; week 0–week 24, 0.92±0.15 m/s, p= 0.02) (AIx@75; week 0–week 24, 3.59±0.33%, p= 0.03).On the other hand, CAVI and A,hx@75 were not attenuated significantly by ABT (CAVI; week 0–week 24, 0.22±0.11 m/s, p= 0.52) (AIx@75; week 0–week 24, 0.98±0.21%, p= 0.66). The change (week 0–week 24) CAVI and AIx@75 of the TCZ group were significantly improvement than those of the ABT group (TCZ vs. ABT, CAVI: p= 0.024; AIx@75: p=0.032). TCZ and ABT did not significantly change carotid intima-media thickness (week 0–week 24, TCZ: 0.00±0.11 mm, ABT: -0.00±0.13 mm), and did not produce significant changes in carotid artery plaque (week 0–week 24, numbers of combined grade 0/1/2/3/4, TCZ: -1/1/0/0, ABT: -1/0/-0/0). There were no significant changes either within ratio of serum total cholesterol (TC) to high-density lipoprotein cholesterol (week 0–week 24, TCZ: 0.02±0.04; ABT: 0.03±0.03) (p>0.05). In the TCZ, TC was significantly increased (week 0–week 24, -18.0±5.2 mg/dL, p= 0.03). There were no significant changes within the ABT group in TC (ABT: -2.0±0.6 mg/dL; p=0.75). The change TC levels of the TCZ group were significantly higher than those of the other groups (TCZ vs. ABT, p= 0.034). DAS28 and CRP improved significantly in both groups (week 0–week 24; DAS28, TCZ: -2.13±0.35, ABT: -2.20±0.42) (CRP, TCZ: 22.3±3.2 mg/l, ABT: 19.5±2.3 mg/l) (p<0.05). They were no significant difference between groups.

Conclusion:

TCZ improves arterial stiffness compared with ABT and in TNF blockers resistant RA. If RA patients were resist TNF blocker, we might think the patients were treated by TCZ than ABT.

To cite this abstract, please use the following information:
Kume, Kensuke, Amano, Kanzo, Yamada, Susumu, Hatta, Kazuhiko; Tocilizumab Improves Arterial Stiffness Compared with Abatacept In Patients with TNF Blockers-Resistant Active Rheumatoid Arthritis.An Open Label Randomized Controlled Trial. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :395
DOI:

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