Modern Rheumatology

, Volume 23, Issue 5, pp 977–985 | Cite as

Monitoring C-reactive protein levels to predict favourable clinical outcomes from tocilizumab treatment in patients with rheumatoid arthritis

  • Toshihisa Kojima
  • Yuichiro Yabe
  • Atsushi Kaneko
  • Yuji Hirano
  • Hisato Ishikawa
  • Masatoshi Hayashi
  • Hiroyuki Miyake
  • Hideki Takagi
  • Takefumi Kato
  • Kenya Terabe
  • Tsuyoshi Wanatabe
  • Hiroki Tsuchiya
  • Daihei Kida
  • Tomone Shioura
  • Koji Funahashi
  • Daizo Kato
  • Hiroyuki Matsubara
  • Nobunori Takahashi
  • Yosuke Hattori
  • Nobuyuki Asai
  • Naoki Ishiguro
Original Article

Abstract

Objectives

The inflammatory cytokine interleukin-6 (IL-6) directly stimulates C-reactive protein (CRP) expression. The present study aimed to examine how clinical treatment outcomes of rheumatoid arthritis (RA) with tocilizumab (TCZ), a humanised monoclonal anti-IL-6 receptor antibody, are related to CRP levels monitored for 52 weeks.

Methods

One hundred and twenty-two RA patients who underwent TCZ treatment between May 2008 and September 2009 were registered in the Tsurumai Biologics Communication Registry. Data were collected at initiation of treatment (baseline) and over 52 weeks for Disease Activity Score 28-ESR (DAS28-ESR), Boolean core measurements, serum CRP levels and matrix metalloproteinase-3 levels. To compare clinical results, patients were divided into three groups based on treatment time required to achieve normal CRP levels.

Results

Multivariate analysis using the Cox proportional-hazards regression model found that higher CRP levels at baseline was a significant and independent factor in predicting normal CRP levels over 52 weeks (hazard ratio 0.86 per 1 mg/dL). In contrast, disease duration, concomitant methotrexate use and previous tumour necrosis factor inhibitor failure were not significant factors. Patients with normal CRP levels at 12 weeks of TCZ treatment achieved better clinical outcomes, including remission based on DAS28-ESR criteria, compared to patients with elevated CRP levels at 12 weeks.

Conclusions

Adequate suppression of pathological IL-6 signalling during TCZ treatment improves clinical outcomes and can be monitored with serum CRP levels, a readily available biomarker in clinical practice.

Keywords

Rheumatoid arthritis Tocilizumab C-reactive protein Interleukin-6 

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Copyright information

© Japan College of Rheumatology 2012

Authors and Affiliations

  • Toshihisa Kojima
    • 1
  • Yuichiro Yabe
    • 2
  • Atsushi Kaneko
    • 3
  • Yuji Hirano
    • 4
  • Hisato Ishikawa
    • 3
  • Masatoshi Hayashi
    • 5
  • Hiroyuki Miyake
    • 6
  • Hideki Takagi
    • 7
  • Takefumi Kato
    • 8
  • Kenya Terabe
    • 1
    • 9
  • Tsuyoshi Wanatabe
    • 10
  • Hiroki Tsuchiya
    • 7
  • Daihei Kida
    • 3
  • Tomone Shioura
    • 11
  • Koji Funahashi
    • 1
  • Daizo Kato
    • 1
  • Hiroyuki Matsubara
    • 1
  • Nobunori Takahashi
    • 1
  • Yosuke Hattori
    • 1
  • Nobuyuki Asai
    • 12
  • Naoki Ishiguro
    • 1
    • 12
  1. 1.Department of Orthopaedic Surgery and Rheumatology, Nagoya University HospitalNagoya University School of MedicineNagoyaJapan
  2. 2.Department of RheumatologyTokyo Kosei Nenkin HospitalTokyoJapan
  3. 3.Department of Orthopaedic SurgeryNagoya Medical CentreNagoyaJapan
  4. 4.Department of RheumatologyToyohashi Municipal HospitalToyohashiJapan
  5. 5.Department of RheumatologyNagano Red Cross HospitalNaganoJapan
  6. 6.Department of Orthopaedic SurgeryIchinomiya Municipal HospitalIchinomiyaJapan
  7. 7.Department of Orthopaedic SurgeryNagoya Kyoritsu HospitalNagoyaJapan
  8. 8.Kato Orthopaedic ClinicOkazakiJapan
  9. 9.Department of Orthopaedic SurgeryFukuroi Municipal HospitalFukuroiJapan
  10. 10.Department of Orthopaedic SurgeryKariya-Toyota General HospitalKariyaJapan
  11. 11.Department of Orthopaedic SurgeryShizuoka Kosei HospitalShizuokaJapan
  12. 12.Department of Orthopaedic SurgeryNagoya University, Faculty and Graduate School of MedicineNagoyaJapan

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