title: Is IL-6 an appropriate target to treat spondyloarthritis patients refractory to anti-TNF therapy? A multicentre retrospective observational study.
abstract: BACKGROUND
  The aim of this study was to evaluate, under real-life conditions, the safety and efficacy of tocilizumab in patients having failed anti-TNFα therapy for spondyloarthritis.
  
  
  METHODS
  French rheumatologists and internal-medicine practitioners registered on the Club Rhumatismes et Inflammations website were asked to report on patients given tocilizumab (4 or 8 mg/kg) to treat active disease meeting Assessment of SpondyloArthritis International Society (ASAS) criteria for axial or peripheral spondyloarthritis, after anti-TNFα treatment failure. Safety and efficacy after 3 and 6 months were assessed retrospectively using standardised questionnaires.
  
  
  RESULTS
  Data were obtained for 21 patients, 13 with axial spondyloarthritis (46% men; median age, 42 years; disease duration, 11 years; HLA-B27-positive, 92.3%) and eight with peripheral spondyloarthritis (25% men; median age, 40 years; disease duration, 10 years; HLA-B27-positive, 62.5%). No patients with axial disease had at least a 20 mm decrease in the BASDAI, nor a BASDAI50 response or major ASAS-endorsed disease activity score improvements after 3 or 6 months; an ASAS-endorsed disease activity score clinically important improvement was noted at month 3 in five of 13 patients and at month 6 in one of four patients. A good DAS28 response was achieved in four patients with peripheral disease, including one in EULAR remission at month 3. Four patients were still taking tocilizumab at month 6, including one in EULAR remission and one with a good DAS28 response. Tocilizumab was well tolerated, with no serious adverse events. Initially elevated acute-phase reactants declined during tocilizumab therapy.
  
  
  CONCLUSIONS
  In patients having failed anti-TNFα therapy, tocilizumab decreased acute-phase reactants but failed to substantially improve axial spondyloarthritis and was inconsistently effective in peripheral spondyloarthritis.
authors.affiliation: Rheumatology Department, AP-HP, Henri Mondor University Hospital, 51 avenue du Mal de Lattre de Tassigny, 94010 Créteil, France.
authors.forename: Fernando Kemta
authors.initials: FK
authors.lastname: Lekpa
authors.forename: Cécile
authors.initials: C
authors.lastname: Poulain
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.forename: Martin
authors.initials: M
authors.lastname: Soubrier
authors.forename: Michel
authors.initials: M
authors.lastname: De Bandt
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Berthelot
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaudin
authors.forename: Eric
authors.initials: E
authors.lastname: Toussirot
authors.forename: Philippe
authors.initials: P
authors.lastname: Goupille
authors.forename: Thao
authors.initials: T
authors.lastname: Pham
authors.forename: Jérémie
authors.initials: J
authors.lastname: Sellam
authors.forename: Rémy
authors.initials: R
authors.lastname: Bruckert
authors.forename: Muriel
authors.initials: M
authors.lastname: Paul
authors.forename: Valérie
authors.initials: V
authors.lastname: Farrenq
authors.forename: Pascal
authors.initials: P
authors.lastname: Claudepierre
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000378:metabolism; D016503:Drug Delivery Systems / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D025241:Spondylarthritis / Q000188:drug therapy* / Q000378:metabolism; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism; D000093242:Interleukin-6 Inhibitors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D000093242:Interleukin-6 Inhibitors; C502936:tocilizumab