Background: Tocilizumab is a humanized monoclonal antibody against the interleukin 6 receptor. Large placebo-controlled randomized studies analysing the effects of tocilizumab led to its approval for clinical use in the USA and Europe in combination with methotrexate or as monotherapy.
Aim of the study: The aim of this study was to analyse the dynamics of subjective symptoms and objective signs of disease activity in Slovak patients with moderate to severe rheumatoid arthritis treated with tocilizumab.
Material and methods: This open-label single-centre non-randomized interventional study involved 32 patients with moderate to severe rheumatoid arthritis (Table I). Tocilizumab was administered every 4 weeks in a dose of 8 mg/kg bodyweight. Patients were followed for a period of 24 weeks. Assessment included the visual analogue scale (VAS) of pain, the Health Assessment Questionnaire (HAQ), as well as the number of tender and swollen joints. Biochemical parameters of inflammation such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured during the study. The DAS28 score, a standardized measure of disease activity in rheumatoid arthritis, was calculated.
Results: Tocilizumab treatment reduced VAS and HAQ scores by 75% and 34%, respectively. The number of tender and swollen joints decreased, on average, from 26 to 4 and from 16 to less than 1 per patient, respectively. Inflammation markers were reduced by 80% (ESR) and by 83% (CRP). DAS28 score decreased on average by 63% after 24 weeks of treatment (Fig. 1). All observed parameters were significantly lower after just 4 weeks of treatment with tocilizumab, following a single dose (Table II, p < 0.001).
Discussion: Tocilizumab is an effective medication for patients with moderate to severe rheumatoid arthritis. Rapid effects were observed, both on subjective symptoms and objective parameters of disease activity. This is the first study conducted solely on Slovak patients with rheumatoid arthritis showing the effects of inhibition of the interleukin 6 receptor. Further studies should focus on tocilizumab usage in larger cohorts of patients with the potential to uncover the causes of treatment benefit variability.
Conclusions: This study showed that treatment of patients suffering from moderate to severe rheumatoid arthritis with tocilizumab results in a rapid and lasting reduction of both subjective symptoms and objective signs of inflammation.