Background/Purpose: First-line treatment for relapsing polychondritis (RP) is costicosteroids (CS). Dapsone and methotrexate have been proposed as second-line therapies. Only few reports have been published on the use of biologics in RP. There may be a publication bias favouring successful issues. This work was aimed at colligating and describing the effects of biologics in RP patients in our Department.

Methods: Diagnosis codes are given and registered in a computerized medical file for each patient treated in our department since 1993. We performed the extraction of all cases encoded as “RP”. The diagnosis was confirmed using Damiani’s McAdam-modified criteria. All patients treated with biologics were evaluated for efficacy and adverse drugs reactions until the 20^th June 2012 (last follow-up date).

Results: Among 22 patients encoded “RP”, 17 fulfilled Damiani’s criteria. Among them, 8 were exposed to 19 biologics as CS-sparing drugs. Mean age at diagnosis was 45.7 years and male:female sex-ratio was 1:4. All patients had chondritis and seronegative polyarthritis, 4 had cochlear or vestibular dysfunction and 2 had ocular inflammation. Biologics were used at the same doses as in rheumatoid arthritis. Seven patients were treated with TNF-alpha antagonists (adalimumab, n=7, etanercept, n=3, infliximab, n=2, certolizumab, n=1), 2 with anakinra, 2 with abatacept and 2 with tocilizumab. Treatments used before biologics were CS (all patients), methotrexate (n=3), dapsone (n=2), hydroxychloroquine (n=4), azathioprine (n=1). In 3 cases (patients 4, 6 and 8), biologics were used because of a cortico-dependant and severe disease (tracheal inflammation). Mean delay from diagnosis to first biologic use was 9.75 months. Outcomes are described in table 1. Seven adverse drug reactions were considered as drug-related: reactions at injection site occurred in 2 patients (1 on anakinra, 1 on adalimumab), and infections in 3 patients (1 pneumonia on adalimumab, sinusitis and otitis followed by herpes zoster on tocilizumab, 1 cellulitis on abatacept).

Conclusion: All biologics but anakinra and certolizumab in one patient had a consistent effect. Loss of efficacy occurred frequently. Switching from a TNF-alpha antagonist to another TNF-alpha antagonist was frequently efficacious and may be proposed before switchting to abatacept or tocilizumab. The benefit-to-risk ratio of biologics compared with immunosuppressive drugs should be evaluated prospectively in RP.

Table 1. Outcomes of the 19 biologic therapies.