Session Type: Poster Session (Tuesday)
Session Time: 9:00AM-11:00AM
Background/Purpose: The asymptotic individuals with the human T lymphotropic virus type I (HTLV-I) infection rarely develop adult T cell leukemia/lymphoma (ATL) or HTLV-I–associated myelopathy (HAM). In addition, HTLV1 infection is also associated with rheumatic disease such as HTLV-I–associated arthropathy, rheumatoid arthritis (RA), and Sjogren’s syndrome. The HTLV-I virus infects not only primarily CD4+ T lymphocytes but also synovial fibroblasts and salivary gland epithelial cells, and the HTLV-I infections modify the functions of these cells and induce various inflammatory conditions. Therefore, it is important clinical issue whether HTLV-I infection changes the pathological condition and the therapeutic response in patients with rheumatic disease.
Our previous study has showed that the efficacy of tumor necrosis factor inhibitor (TNFi) was attenuated in anti–HTLV-I antibody–positive patients with RA. However, no previous reports have examined the comparative efficacy and safety between anti–HTLV-I antibody–negative and –positive RA patients when they are treated with non-TNFi biologics.
We aimed to evaluate the efficacy and safety of tocilizumab (TCZ) in anti–HTLV-I antibody–positive patients with RA compared with those negative patients using a multicenter retrospective cohort.
Methods: The present study reviewed Japanese RA patients who TCZ was newly introduced as a first biologics between April 2008 and September 2018 at 7 participating rheumatology centers in Nagasaki and Miyazaki Prefecture in Japan, which are known as endemic areas of HTLV-I infection. Patients with unclear anti–HTLV-I antibody status and patients with remission at baseline were excluded. Overall, the outcomes of 184 patients treated with TCZ were analyzed. The primary end point was the change in the patients’ clinical disease activity index (CDAI) between entry and 6 months after the initiation of TCZ treatment. We also analyzed the occurrence of ATL or HAM during TCZ treatment periods for 6 months.
Results: Enrolled total 184 patients were divided into anti–HTLV-I antibody–negative and –positive groups of 167 (90.8%) and 17 (9.2%). The median age at baseline and doses of concomitant methotrexate were significantly higher in anti–HTLV-I antibody–positive group (p = 0.009, p = 0.04, respectively). In addition, each indicator of clinical disease activity score at baseline was also significantly higher in anti–HTLV-I antibody–positive group. The CDAI score decreased significantly at 6 months in anti–HTLV-I antibody–positive group compared with anti–HTLV-I antibody–negative group (p = 0.05), and persistence with TCZ tended to be higher in anti–HTLV-I antibody–positive group. Multiple regression analysis demonstrated that anti–HTLV-I antibody status tended to be associated with the CDAI score’s improvement but was not significant. No patients developed ATL or HAM during TCZ treatment periods for 6 months.
Conclusion: Our results indicate that TCZ treatment tend to confer prefer response in anti–HTLV-I antibody–positive patients with RA, but further investigations are desired.
To cite this abstract in AMA style:Endo Y, Umekita K, Nakamura H, Fukui S, Suzuki T, Miyamoto J, Shimizu T, Koga T, Kawashiri S, Iwamoto N, Ichinose K, Tamai M, Origuchi T, Okada A, Fujikawa K, Mizokami A, Matsuoka N, Aramaki T, Ueki Y, Eguchi K, Kariya Y, Hashiba Y, Hidaka T, Okayama A, Kawakami A. Efficacy and Safety of Tocilizumab Treatment for Anti–human T Lymphotropic Virus Type I Antibody–positive Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/efficacy-and-safety-of-tocilizumab-treatment-for-anti-human-t-lymphotropic-virus-type-i-antibody-positive-rheumatoid-arthritis/. Accessed December 1, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-and-safety-of-tocilizumab-treatment-for-anti-human-t-lymphotropic-virus-type-i-antibody-positive-rheumatoid-arthritis/