title: Comparison of the clinical utility of tocilizumab and anti-TNF therapy in AA amyloidosis complicating rheumatic diseases.
abstract: OBJECTIVE
  Anti-cytokine therapy is reportedly useful in amyloid A (AA) amyloidosis complicating rheumatic diseases. However, to date no studies have directly compared the utility of tumour necrosis factor (TNF) inhibition to that of interleukin-6. The aim of our retrospective study was to compare the clinical utility of tocilizumab (TCZ) and anti-TNF (TNF inhibitor) therapy.
  
  
  METHODS
  We studied 42 patients treated with anti-cytokine agents at our hospital: 31 had received a single agent, ten had received two agents and one had received three agents. Patients were divided into a TCZ group (22 patients) and a TNF inhibitor group (32 patients). The main parameters compared were treatment retention rate, serum amyloid A (SAA) profile, renal function profile and clinical disease activity index.
  
  
  RESULTS
  The 5-year retention rates were 90.4 (TCZ group) and 34.3 % (TNF inhibitor group) (p = 0.0154, log-rank test). The median SAA fell from 219.2 μg/mL at treatment initiation to 5.0 μg/mL at last observation (TCZ), and from 143.6 to 38.1 μg/mL (TNF inhibitor) (p = 0.0194). Estimated glomerular filtration rate was improved in 72.7 (TCZ) and 34.4 % (TNF inhibitor) of patients (p = 0.0062). The rates of clinical remission or low disease activity at last observation for the TCZ and TNF inhibitor groups were 72.7 and 40.7 % (p = 0.0201), respectively.
  
  
  CONCLUSIONS
  Based on these results, we conclude that TCZ was of greater clinical utility than anti-TNF therapy in our patients with AA amyloidosis complicating rheumatic diseases.
authors.affiliation: Department of Internal Medicine, Center for Rheumatic Diseases, Dohgo Spa Hospital , 21-21 Otsu Dohgo-Himezuka, Matsuyama, Ehime 790-0858 , Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Okuda
authors.forename: Makoto
authors.initials: M
authors.lastname: Ohnishi
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Matoba
authors.forename: Kazuo
authors.initials: K
authors.lastname: Jouyama
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yamada
authors.forename: Naoya
authors.initials: N
authors.lastname: Sawada
authors.forename: Sho
authors.initials: S
authors.lastname: Mokuda
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Murata
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Takasugi
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000150:complications / Q000188:drug therapy*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; C502936:tocilizumab