The skin of patients with systemic sclerosis softened during the treatment with anti-IL-6 receptor antibody tocilizumab.
OBJECTIVE
SSc is an autoimmune disease characterized by fibrosis of the skin and internal organs. Although the aetiology remains uncertain, many reports have suggested that IL-6 is involved in SSc pathogenesis. Tocilizumab, an anti-IL-6 receptor antibody, is an anti-arthritis medicine that works through the blockade of IL-6 functions. To examine the effect of tocilizumab on SSc, we administered tocilizumab to two SSc patients.


METHODS
Two dcSSc patients were administered tocilizumab at 8 mg/kg once a month for 6 months. One patient had pulmonary fibrosis assessed by CT and spirometry, and the other had chronic renal failure caused by scleroderma renal crisis. Their skin condition was monitored with a Vesmeter and the modified Rodnan total skin score (mRTSS). Skin biopsies were obtained before and after the tocilizumab treatment to investigate the histological changes.


RESULTS
After tocilizumab treatment, both patients showed softening of the skin with reductions of 50.7 and 55.7% in the total z-score of Vesmeter hardness and 51.9 and 23.0% in the mRTSS, respectively. Histological examination showed thinning of the collagen fibre bundles in the dermis. The creatinine clearance in the patient with chronic renal failure improved from 38 to 55 ml/min. However, the fibrotic changes in the lung in the other patient remained unchanged.


CONCLUSIONS
In the two cases of SSc that we report here, softening of the skin was observed during the treatment with tocilizumab.
Shima
Yoshihito
Y
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. ryanjin@imed3.med.osaka-u.ac.jp
Kuwahara
Yusuke
Y
Murota
Hiroyuki
H
Kitaba
Shun
S
Kawai
Mari
M
Hirano
Toru
T
Arimitsu
Junsuke
J
Narazaki
Masashi
M
Hagihara
Keisuke
K
Ogata
Atsushi
A
Katayama
Ichiro
I
Kawase
Ichiro
I
Kishimoto
Tadamitsu
T
Tanaka
Toshio
T
D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000276:immunology / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000276:immunology / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000276:immunology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019947:Receptors, Interleukin-6 / Q000276:immunology / Q000627:therapeutic use*; D012595:Scleroderma, Systemic / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects*
D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D019947:Receptors, Interleukin-6; C502936:tocilizumab
Am J Respir Crit Care Med. 1994 May;149(5):1260-5
8173768
Ann Allergy. 1994 Dec;73(6):493-6
7998663
Ann Rheum Dis. 2009 May;68(5):620-8
19147617
Arthritis Rheum. 1990 Aug;33(8):1256-63
2390128
Am J Pathol. 1990 Sep;137(3):585-91
1698026
Blood. 2008 Nov 15;112(10):3959-64
18784373
J Rheumatol. 1992 Aug;19(8):1207-11
1404155
Rheumatology (Oxford). 2008 Jul;47(7):1018-24
18440998
J Dermatol Sci. 2001 Oct;27(2):140-6
11532378
J Clin Invest. 1999 May;103(9):1253-60
10225968
J Rheumatol. 1998 Feb;25(2):308-13
9489824
Arthritis Rheum. 1980 May;23(5):581-90
7378088
Arthritis Care Res. 1991 Mar;4(1):27-31
11188583
Arthritis Rheum. 2006 Nov;54(11):3655-60
17075814