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.


Outcomes of Systemic Sclerosis Associated Polyarthritis Patients Treated by Biotherapies Tocilizumab or Abatacept: A EUSTAR Observational Study.

Meunier1,  Marine, Cerinic2,  Marco Matucci, Maurer3,  Britta, Riemekasten4,  Gabriela, Pellerito5,  Raffaele, von Muhlen6,  Carlos Alberto, Vacca7,  Alessandra

Paris Descartes University, Rheumatology A department, Cochin Hospital, Paris, France
Department of Internal Medicine, Rheumatology Section, Transition Clinic, University of Florence, Firenze, Italy
Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
Charité University Hospital, German Rheumatology Research Center, a Leibniz Institute, Berlin, Germany
Ospedale Mauriziano, Torino, Italy
Rheumatology Department, Saint Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil, Porto Alegre, Brazil
Chair of Rheumatology II, Department of Medical Sciences, University of Cagliari, Italy, Cagliari, Italy
Brescia, Italy
University Hospital Zurich, Zurich, Switzerland

Background/Purpose:

Joint involvement is frequent in systemic sclerosis (SSc) and up to 30% can develop clinical signs of synovitis or tenosynovitis (1). Treatment is not standardized and polyarthritis is not uncommonly refractory to DMARDS. Biologic agents are increasingly used in inflammatory rheumatic conditions. Among them, tocilizumab and abatacept have proven to be effective in rheumatoid arthritis but no trial has been performed SSc. The aim of this study was to evaluate the safety and effectiveness of tocilizumab and abatacept in SSc-polyarthritis, in a prospective multicenter observational study.

Methods:

By querying the EUSTAR network, 13 SSc patients with active polyarthritis and insufficient response to DMARDS were included. Patients received tocilizumab or abatacept upon the decision of their physician in routine practice: 9 patients received tocilizumab at 8 mg/kg/month and 4 patients abatacept at 10 mg/kg/month. Clinical and biological assessments were carried out at treatment initiation and before the last infusion.

Results:

The majority of patients were followed 6 months (9/13) but the last data were only obtained at 3 months for 4 patients. Mean age was 50±10 years, mean disease duration 10±5 years, 46% of patients had a diffuse cutaneous sub-type, 4 patients had positive anti-CCP antibodies. 3 out of 12 patients had severe lung fibrosis. Patients received biotherapy in association with DMARDs (n=9) or alone (n=4).

Tocilizumab induced a significant response for joint involvement with a mean DAS28 decrease of 2.2±1.2 (2.8±1 before the last infusion versus 5.0±0.9 at baseline, p<0.0001) a mean tender joints decrease of 6.5 (4.7±7 versus 11.2±7) and a mean swollen joints decrease of 4 (1.2±1.8 versus 5.2±5). 6/9 patients receiving tocilizumab achieved EULAR good response. Rodnan's skin score did not significantly change (8±8 versus 9±9, p=0.8) and neither quality of life (HAQ 1.4±0.5 versus 1.7±0.7, p=0.6). Treatment was stopped for three patients: two because of insufficient improvement and one for elevation of liver enzymes.

Abatacept induced a significant response for joint involvement with a mean DAS28 decrease of 1.8±0.9 (2.6±0.6 versus 4.4±1.1 at baseline, p=0.03), a mean tender joints decrease of 2.8 (1.2±0.9 versus 4.0±1.8) and a mean swollen joints decrease of 3.8 (0.2±0.5 versus 4.0±1.8). 3/4 patients receiving abatacept fulfilled EULAR good response criteria. Rodnan's skin score did not significantly change (10±7.6 versus 9±7.4, p=0.8) and neither quality of life (HAQ 0.7±0.2 versus 0.9±0.3, p=0.2).

Conclusion:

In this very preliminary pilot study, both tocilizumab and abatacept appeared to be safe and to improve joint involvement after 3 to 6 months in refractory SSc arthritis patients. The follow-up is too short to estimate the impact on the fibrotic lesions. A larger number of cases is expected to be included with the support of EUSTAR network. Larger studies with longer follow-up are warranted to further determine the safety and efficacy of these drugs in SSc, and potentially raise the opportunity of developing randomised controlled trials.

To cite this abstract, please use the following information:
Meunier, Marine, Cerinic, Marco Matucci, Maurer, Britta, Riemekasten, Gabriela, Pellerito, Raffaele, von Muhlen, Carlos Alberto, et al; Outcomes of Systemic Sclerosis Associated Polyarthritis Patients Treated by Biotherapies Tocilizumab or Abatacept: A EUSTAR Observational Study. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1462
DOI:

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