Association of tocilizumab treatment with changes in measures of regional left ventricular function in rheumatoid arthritis, as assessed by cardiac magnetic resonance imaging.
OBJECTIVE
The goal of this study was to determine whether the powerful anti-inflammatory effect of anti-interleukin-6 with tocilizumab (TCZ) might lead to a reduction in left ventricular (LV) dysfunction in patients with rheumatoid arthritis (RA).


METHODS
Consecutive RA patients with active disease and healthy control subjects without a clinical diagnosis of cardiovascular disease were enrolled. The RA patients each had inadequate clinical response to non-biologic disease-modifying anti-rheumatic drugs and were prescribed TCZ therapy. All subjects underwent baseline evaluation of LV function, as measured by cardiac magnetic resonance imaging (CMRI). Peak systolic regional radial strain (Err, %) was calculated by feature tracking of cine CMRI. After baseline (BL) CMRI measurements, treatment with TCZ was initiated, and patients were followed for 52 weeks. We compared peak Err of RA patients at BL and at 52 weeks.


RESULTS
Thirteen RA patients (mean age 52.6 ± 5.4 years) were assessed at BL and at 52 weeks, and these patients were compared with 10 non-RA controls (mean age 55.7 ± 4.6 years). Disease Activity Score of 28 joints - erythrocyte sedimentation rate and Simple Disease Activity Index were significantly lower in RA patients at 52 weeks than at BL. Mean peak Err at BL in RA patients was significantly lower than in normal subjects (P = 0.03). Mean peak Err was significantly higher at 52 weeks than at BL (P = 0.028) in RA patients.


CONCLUSIONS
We showed that TCZ was associated with left ventricular dysfunction in RA patients which correlated with a reduction in RA disease activity.
Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan.
Yasuyuki
Y
Kobayashi
Divisions of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.|Division of Rheumatology, Itabashi Chuo Medical Center, Tokyo, Japan.
Hitomi
H
Kobayashi
Division of Rheumatology, Columbia University, College of Physicians and Surgeons, New York City, New York, USA.
Jon T
JT
Giles
Division of Cardiology, Tokyo Medical Collage, Tokyo, Japan.
Masaharu
M
Hirano
Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan.
Yasuo
Y
Nakajima
Divisions of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Masami
M
Takei
D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D058070:Asymptomatic Diseases; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors; D014041:Tokyo; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D016277:Ventricular Function, Left / Q000187:drug effects*
D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab
cardiac magnetic resonance imaging; rheumatoid arthritis; tocilizumab; ventricular regional function