Endocrine Abstracts

Tocilizumab is an interleukin-6 receptor antagonist used in the treatment of rheumatoid arthritis (RA). It is known to induce remission and inhibit radiographic progression in RA. Tocilizumab may be administered either intravenously or subcutaneously. Its effect on lipid levels and the cardiovascular risk has not been fully investigated. The aim was to study the effect of tocilizumab i.v. on disease activity, lipid levels and cardiovascular risk in RA patients.

Tocilizumab was administered i.v. once monthly in 25 patients with RA for a period of 1 year. Inflammation indices, ESR and CRP and lipid levels were measured before and 1 year after tocilizumab administration. The DAS28 disease activity index was also calculated.

Inflammation indices ESR and CRP decreased from 34.3±4.04 mm/h and 2.02±0.34 mg/dl before to 8.3±1.62 mm/h and 0.27±0.07 mg/dl, respectively (P<0.001) after tocilizumab administration. The DAS28 disease activity index decreased from 5.02±0.26 to 2.42±0.26 after tocilizumab (P<0.001). Total cholesterol and HDL cholesterol increased from 207.4±8.53 mg/dl and 57.68±2.65 mg/dl before to 231.08±12.30 mg/dl and 72.51±4.76 mg/dl, respectively (P<0.001) after tocilizumab administration, LDL cholesterol and triglyceride levels increasing from 128.6±7.45 mg/dl and 108.48±7.83 mg/dl before to 136.17±9.39 mg/dl and 130.58±15.82 mg/dl, respectively (P<0.001) after tocilizumab. No acute cardiovascular events were recorded during the study.

Tocilizumab administered i.v. in patients with RA was shown to decrease inflammation indices and disease activity. Lipid levels increased significantly. However, total cholesterol increased in parallel with HDL cholesterol. Cardiovascular events were not observed during the study period. It appears that tocilizumab may be accompanied by lipid level alterations, cardiovascular risk not increasing as the adverse effects of total cholesterol may be counteracted by HDL cholesterol.