title: Study on the safety and efficacy of tocilizumab, an anti-IL-6 receptor antibody, in patients with rheumatoid arthritis complicated with AA amyloidosis.
abstract: OBJECTIVE
  Although treatment of rheumatoid arthritis (RA) has progressed by the use of biologics, amyloid A (AA) amyloidosis is still an intractable complication in patients with RA. In the present study, safety and efficacy of 1-year treatment with an anti-IL-6 receptor antibody tocilizumab (TCZ) on RA and AA amyloidosis were estimated.
  
  
  METHODS
  TCZ (8 mg/kg every 4 weeks) was administered to five RA patients complicated with AA amyloidosis. The primary end point was improvement in renal dysfunction and the secondary end point was CDAI at 1 year after the treatment.
  
  
  RESULTS
  An improvement in the renal dysfunction, including urinary protein secretion, was found, in four patients including two patients who were refractory to etanercept, with a remarkable decrease of SAA concentration, and the progression of organ dysfunction was prevented at 1 year in all patients treated with TCZ. The mean clinical disease activity index decreased from 33.9 to 4.7 (p = 0.012) in five patients treated with TCZ for 1 year. Three non-serious adverse events were observed in two patients.
  
  
  CONCLUSIONS
  TCZ ameliorates renal dysfunction in RA patients complicated with AA amyloidosis who are refractory to conventional therapies, thereby suggesting that TCZ has a potential to regulate AA amyloidosis.
authors.affiliation: The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health , Kitakyushu , Japan.
authors.forename: Ippei
authors.initials: I
authors.lastname: Miyagawa
authors.forename: Shingo
authors.initials: S
authors.lastname: Nakayamada
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Saito
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hanami
authors.forename: Masao
authors.initials: M
authors.lastname: Nawata
authors.forename: Norifumi
authors.initials: N
authors.lastname: Sawamukai
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Nakano
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Yamaoka
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000150:complications / Q000188:drug therapy*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors; D000685:Serum Amyloid A Protein / Q000032:analysis; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D019947:Receptors, Interleukin-6; D000685:Serum Amyloid A Protein; C113250:interleukin-6 receptor alpha; C502936:tocilizumab