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Tocilizumab Improves Arterial Stiffness As Well As Other Biologics with Methotrexate-Resistant Active Rheumatoid Arthritis-An Open Label, Randomized Cohort Multi Center Study

Kensuke Kume, Kanzo Amano, Susumu Yamada, Kazuhiko Hatta, Kuniki Amano, Hiroyuki Ohta, Noriko Kuwaba

Objectives: To compare the effects of tocilizumab (TCZ) plus methotrexate (MTX), etanercept (ETN) plus MTX, and infliximab (IFX) plus MTX, respectively on arterial stiffness in rheumatoid arthritis (RA) patients despite MTX treatment, in an open-label, randomized study.

Methods: 62 RA patients with moderate to severe active disease despite MTX treatment were randomly assigned to receive TCZ plus MTX (n=21), ETN plus MTX (n=21), or IFX plus MTX (n=20). All patients have no previous history of CV. 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. Clinical data were collected at regular visits.

Results: The characteristics of each group at baseline were not significantly different. In all groups there was significant attenuation from baseline to 24 weeks follow-up in CAVI(TCZ: p=0.01; ETN: p=0.03; IFX:p=0.02) and in AIx@75 (TCZ: p=0.01; ETN: p= 0.03; IFX: p=0.02). There were no significant differences between each group in measures of CAVI (p=0.53) or AIx@75 (p=0.55). There were no significant changes in cardiovascular risk factors either within or between groups.

Conclusions: Therapy of TCZ, ETN, or IFX combined with MTX, reduced arterial stiffness in RA patients. These findings suggest that combination therapy to block IL6 with MTX not only reduced RA disease activity but also limited vascular damage in patients with RA by blocking TNF.