Background/Purpose:  Tocilizumab, interleukin-6 receptor antibody is very effective in patients with rheumatoid arthritis (RA). Anti-cyclic citrullinated protein antibodies (ACPA) are highly specific and sensitive for RA. There are several reports that the correlation between the efficacy of anti-tumor necrosis factor and the titer of ACPA. There is no evidence that the correlation between the efficacy of Tocilizumab and ACPA.To investigate the Tocilizumab on ACPA, and its association with treatment response.

Methods: RA patients were eligible if they had active disease despite treatment with methotrexate (MTX).  Fifty four consecutive IgM-rheumatoid factor positive patients with RA were treated with infusion of 8mg/kg tocilizumab every 4 weeks.Disease activity was assessed by DAS28 score. ACPA titer was measured by a commercial ELISA at Week 0 and Week 24.The primary outcome was correlation between clinical response to therapy and ACPA titer. Secondary outcome was the change of ACPA titer from baseline to week 24.

Results: Primary outcome: There was a significant correlation between clinical response to therapy and ACPA titer(r=0.54, p<0.02). Secondary outcome: There was no change of ACPA titer from baseline to week 24(p=0.76). No patient at baseline turned negative at week 24 for ACPA (negative cut off<4.5U/ml).

Conclusion: ACPA titer might be predictor of the efficacy of Tocilizumab in patients with RA. Tocilizumab treatment didn’t affect the change of ACPA titer.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/anti-cyclic-citrullinated-protein-antibodies-as-a-predictor-of-response-to-tocilizumab-in-patients-with-rheumatoid-arthritis-a-prospective-study/