Tocilizumab Decreases Left Ventricular Dysfunction in Rheumatoid Arthritis Patients

While tocilizumab, an IL-6 agonist, is an FDA-certified treatment for rheumatoid arthritis, its effects on myocardial regional function hasn’t been studied with MRI. This is important because rheumatoid arthritis patients have lower physical activity rates, possibly masking congestive heart failure (CHF) symptoms. Subclinical left ventricular dysfunction is a CHF predictor, and can be identified by noninvasive cardiac magnetic resonance imaging (CMRI).  A small Japanese pilot study’s goal was to see if tocilizumab reduced left ventricular regional dysfunction in rheumatoid arthritis patients with no history of cardiovascular disease.[[{"type":"media","view_mode":"media_crop","fid":"42840","attributes":{"alt":"©SebastianKaulitzki/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_680316386278","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4659","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"","typeof":"foaf:Image"}}]] The study included 13 patients with rheumatoid arthritis as well as 10 healthy control subjects, also with no diagnosed cardiovascular disease. The study used all women, and subjects were all about the same age. The rheumatoid arthritis subjects had high disease activity, with a disease duration around 30 months. That group was given tocilizumab therapy for one year. All subjects were evaluated at baseline and 52 weeks with CMRI for left ventricular dysfunction, with the interpreting radiologists blinded to their clinical information. Researchers found that the tocilizumab treatment was highly effective on peak systolic radial strain, improving left ventricular function in all 13 rheumatoid arthritis patients by the end of the study. At baseline, the mean peak radial strain (Err) was 0.56 (range 0.51-0.64), while at 52 weeks it was 0.67 (range 0.59-0.76). They also found that Err was significantly lower at baseline for the rheumatoid arthritis group compared to the control group, while at 52 weeks, the two groups weren’t significantly different. Researchers concluded that tocilizumab improved left ventricular dysfunction in rheumatoid arthritis patients, in addition to reducing their rheumatoid arthritis disease activity.  

References:

Kobayashi, Yasuyuki, Kobayashi, Hitomi et al.

"Association of tocilizumab treatment with changes in measures of regional left ventricular function in rheumatoid arthritis, as assessed by cardiac magnetic resonance imaging,"

The International Journal of Rheumatic Diseases

, 2015.