Search

Background IL-6r targeting therapy has been proven to be effective and safe in Giant Cell arteritis (GCA) as well in Takayasu arteritis (TA) in RCTs, probably because of the similar pathologic findings and vessel size (Large Vessel Vasculitis, LVV). However, real world data are scarce. Objectives The aim of the study was to evaluate the effectiveness of Tocilizumab for LVV in real life settings. Methods We retrospectively evaluated, from 2011 to 2017, the outcomes (including glucocorticoid dosage) in patients affected by LVV (according to 1990 aCR classification criteria) who received 8 mg/kg iv Tocilizumab (TCZ) monthly, due to the inadequate response to immunosuppressant. Demographic and clinical characteristics and laboratory findings were collected at baseline and consecutive follow up visits, over 52 weeks. Statistical analysis was performed using the GraphPad Software ver. 6.0 (San Diego CA USA) using appropriate tests. Results We analyzed n.10 patients (6/10 GCA, 4/10 TA) with mean age (± SD) 56 ± 21 years and mean disease duration 41±38 months. Eight out of 10 patients were female. Over the entire observation period, 7/10 also received concomitant methotrexate (mean dose 12.8 ± 2.7 mg/week) while 2/10 received azathioprine (100 mg/day). Median (IQR) prednisone equivalent dose at baseline was 22.5 (10-25) mg/day. At baseline, median ESR was 49 (31-58) mm/h and median CRP level was 15.4 (1.95-28.53) mg/l. Upon TCZ treatment we observed a good disease control in absence of headache, fever and other LVV clinical signs through 52-week follow up. At 52 weeks, we observed a significant reduction of ESR down to 6.5 (2.75-12.25) mm/h as well as of CRP level, down to 1.5 (0.67-3.47) mg/l (p Conclusion In our real life experience iv TCZ was effective and safe in LVV treatment, with a good disease control and a significant steroid-sparing effect. Our preliminary findings need to be confirmed in larger cohorts and prolonged follow-up. References [1] Stone JH, Tuckwell K, Dimonaco S, Klearman M, aringer M, Blockmans D, Brouwer E, Cid MC, Dasgupta B, Rech J, Salvarani C, Schett G, Schulze-Koops H, Spiera R, Unizony SH, Collinson N. Trial of Tocilizumab in Giant-Cell arteritis. N Engl J Med. 2017Jul27;377(4):317-328. doi: 10.1056/NEJMoa1613849. PubMed PMID: 28745999. Disclosure of interests giulia righetti: None declared, vincenzo venerito: None declared, maria giannotta: None declared, Giuseppe Lopalco Speakers bureau: SOBI, BMS, margherita giannini: None declared, Fabio Cacciapaglia: None declared, Laura Coladonato: None declared, Florenzo Iannone Consultant for: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, abbVie, MSD, BMS, Novartis, Lilly, UCB outside this work, Speakers bureau: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, abbVie, MSD, BMS, Novartis, Lilly, UCB outside this work

Background Adipose tissue (AT) is an endocrine organ able to secrete the “adipokine” molecules that contribute to the low-grade inflammatory state in obese subjects and to the local inflammation that affects joints and bone (1,2). High-grade inflammation, in course of RA, leads to an altered body composition (3,4), characterized by the increasing of fat mass and the decreasing of lean mass, mostly not associated to body mass index (BMI) variations (3,5). The BMI is not able to differentiate visceral (VTH) and subcutaneous (STH) fat tissue and to distinguish between muscle mass and fat mass body composition (BC) (6,7). Alternative methods proposed for assessment of visceral fat deposition, are bioelectrical impedance analysis (BIA) and ultrasonography (US). Objectives The aim of the study is to investigate if BC, assessed by BIA and US, correlates with disease activity (assessed by the Disease Activity Score using 28 joint counts – DAS28) and affects the response to the therapy (DAS 28 variation from first evaluation). Methods 87 consecutive RA patients (pts) (72 women and 15 men; aged 52.4±13.2 years; disease duration of 10.7±8.6 years), treated with DMARDs and/or biologics (bDMARDs), were recruited during their regular visit. The inclusion criteria were the 1987 American College of Rheumatology (ACR) or ACR/EULAR 2010 classification criteria. The pts underwent to anthropometric measures (BMI); abdominal US to assess STH and VTH and derived computing of peritoneal circumference (PC); and BIA to the indices of body composition (fat-free mass index (FFMI) and fat mass index (FMI). Results We observed increasing values of BMI, FMI, VTH (fig. 1) and CP with the worsening of disease activity phases, evaluated by DAS 28. In particular, pts with DAS28≥5.1 had highest BMI (30,9±2; p=0,036), FMI (11,5±1,6; p=0,05), CP (92,7±12,5 cm; p=0,035) and VTH (24,8±5,8 mm; p=0,046) than pts in less severe disease activity. By linear regression analysis the predictor of higher DAS28 is the BMI (p=0,028). As regard the drug response, the predictors of DAS 28 improvement are higher FFMI (p=0,044) and lower BMI (p=0,015), independently by bDMARDs or DMARDs treatment. A trend to higher FMI and US AT measures was observed in female with high disease activity, in particular in menopause pts. Conclusions An altered fat distribution is observed in active RA phases; in particular, the FMI increasing is attributable just to visceral AT (VTH and CP). An inflammatory hyperactivity of visceral adiposity could be supposed in RA. The body composition, in addition to BMI, seems to predict the disease activity and drug response in RA patients. The evaluation of VTH by US could be useful to not overestimate the disease activity; instead the BIA could be a useful tool to support the clinicians in a more aggressive treatment management. References Nat Clin Pract Rheumatol 2007; 3(12):716–24. J Mol Endocrinol 2009; 43(1):11–8. Mediators Inflamm 2013; 2013:710928. Arthritis Care Res (Hoboken) 2012; 64(10):1471–9. Nat Rev Rheumatol 2010; 6(8):445–51. Curr Opin Clin Nutr Metab Care 2003; 6(4):387–93. Ann Rheum Dis 2007; 66(10):1316–21. Disclosure of Interest None declared