Session Information
Date: Sunday, November 8, 2015
Title: Rheumatoid Arthritis - Small Molecules, Biologics and Gene Therapy Poster I
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
Tocilizumab (TCZ) is an interleukin 6 (IL-6) inhibitor that is used in Rheumatoid Arthritis (RA) treatment (1). Due to the role played by IL-6 in viral immunosurveillance, we studied the effect of TCZ on the viral load for the Epstein Barr Virus (EBV), Cytomegalovirus (CMV) and Varicella Zoster Virus (VZV) in patients with RA.
Methods:
This was a prospective monocenter study of RA patients taking TCZ. All patients satisfy the 2010 ACR-EULAR classification criteria for RA. Demographic, clinical and laboratory data were collected on each patient. Viral loads (VL) were determined in whole blood (using the Biomerieux EBV and VZV R-gene quantification kit, Abbott Real Time CMV kit) at TCZ initiation and during treatment follow-up. A difference between two viral loads of 0.5log10 copies/ml of whole blood was considered significant.
Results:
22 patients were evaluated. There were 20 (91%) women of a mean age of 57.8 + 11.2 with seropositive and erosive (74%). RA that had been progressing for a mean of 11.3 + 9.7 years. TCZ was administered alone (36.7%) or in combination with methotrexate (MTX) (50%).
When TCZ was introduced, the EBV VL was positive in eight patients with a mean VL value of 1777.2 + 3518.3 (3.5 + 0.4 log10) copies/ml. Only one patient had a positive CMV VL. The VZV VL was negative in all patients. After 9.2 + 4.8 months had lapsed, EBV VL and CMV VL became negative in six of eight patients (p=0.02) and did not significantly vary in the remaining two patients. No VL (EBV, CMV, VZV) became positive. A positive EBV VL did not correlate with RA activity (DAS28ESR, DAS28CRP) or with inflammatory biomarkers (ESR and CRP). RA activity significantly declined after six months of TCZ treatment (DAS28ESR after six months 2.8 + 1.1 vs. 5.14 + 0.9 [p<0.001]).
The treatments of positive EBV patient were collected among 6 patients with EBV VL become negative after TCZ perfusions and 50% of patients did not take any DMARDS.
Conclusion:
In our study, TCZ did not increase the VL of EBV, CMV or VZV. This is the first report on the influence of TCZ on the VL of EBV, CMV and VZV in RA patients. Our EBV results are identical to those that we reported on anti-TNF, which were found by other teams as well (2, 3). Nevertheless, although we did not demonstrate any changes in CMV or VZV VL in patients taking TCZ, but there were reported several cases of severe infection (4;5;6;7). Most of RA patient have still glucocorticoid which can also influence the immunosurveillance for virus (8). Studies involving larger patient populations are necessary.
References:1 Smolen JS.Ann Rheum Dis.2014;73(3). 2 Balandraud N.Athritis rheum.2007;57(5).3 Couderc M.Joint bone spine.2010;77(5).4 VanDuin D.Emerg Infect Dis.2011;17(4).Ogawa JAnn Rheum dis.2006;65(12).6 Kubandova Z.joint bone spine.2010;77(6).7 Roux C.Journal rheumatology 2011;38(2). 8 Glaser R.Neuroendocrinology.1995;62(4).
To cite this abstract in AMA style:
mourgues C, henquell C, Tatar Z, Pereira B, nourisson C, Tournadre A, Soubrier M, Couderc M. Monitoring of Epstein Barr Virus, Cytomegalovirus and Varicella Zooster Virus Load in Patients Receiving Tocilizumab for Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/monitoring-of-epstein-barr-virus-cytomegalovirus-and-varicella-zooster-virus-load-in-patients-receiving-tocilizumab-for-rheumatoid-arthritis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/monitoring-of-epstein-barr-virus-cytomegalovirus-and-varicella-zooster-virus-load-in-patients-receiving-tocilizumab-for-rheumatoid-arthritis/