Tocilizumab Treatment Associated with Cardiovascular Improvements in RA Patients

OCTOBER 29, 2013
Katie Eder
Though rheumatoid arthritis (RA) patients have a significantly higher risk of developing cardiovascular disease (CVD) compared to the general population, results from a pair of studies presented at the American College of Rheumatology 2013 Annual Meeting in San Diego, CA, show that the biologic disease modifier Actemra (tocilizumab) may actually improve the cardiovascular (CV) profiles of RA patients.
As a follow-up to their previous open-label randomized controlled trial that found tocilizumab monotherapy reduces arterial stiffness in RA as effectively as etanercept or adalimumab monotherapy, Kensuke Kume, MD, of the Department of Rheumatology at the Hiroshima Clinic in Japan, and colleagues introduced new findings on the drug’s effects on left ventricular (LV) mass and cardiac output (CO) in RA patients during a poster session on small molecule and biologic RA therapies.
For that cohort study, the researchers administered tocilizumab in addition to methotrexate in 31 patients who had moderate-to-severe RA despite being treated with methotrexate prior to the study. The authors assessed LV morphology and function through cardiac MRI at baseline and 24 weeks, as well as CV risk factors, disease activity scores (DAS28), and C-reactive protein (CRP) levels at regular visits.
At the end of the study period, both left ventricular mass index (LVMI) and CO attenuated considerably with tocilizumab, and even right ventricular mass improved from baseline in 20% of the study participants. Furthermore, DAS28 and CRP improved significantly with the biologic therapy, although the authors noted that “tocilizumab improved LVMI and CO independently of its effects on disease activity.”
Recognizing that tocilizumab inhibits the Interleukin 6 (IL-6) receptor, the researchers concluded that “IL-6 might (play) an important role (in) LV hypertrophy,” which helps explain why tocilizumab “may prevent CV morbidity and mortality in RA.”
However, the authors of a second study proposed that the biologic’s effect on adiponectin levels can better illuminate the improved CV factors in RA patients who receive tocilizumab.

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