Effectiveness and safety of tocilizumab in patients with systemic sclerosis: a propensity score matched controlled observational study of the EUSTAR cohort


Por: Kuster S., Jordan S., Elhai M., Held U., Steigmiller K., Bruni C., Cacciapaglia F., Vettori S., Siegert E., Rednic S., Codullo V., Airo P., Braun-Moscovici Y., Hunzelmann N., Joao Salvador M., Riccieri V., Gheorghiu A.-M., Alegre Sancho J.J., Romanowska-Prochnicka K., Castellví I., Kötter I., Truchetet M.-E., López-Longo F.J., Novikov P.I., Giollo A., Shirai Y., Belloli L., Zanatta E., Hachulla E., Smith V., Denton C., Ionescu R.M., Schmeiser T., Distler J.H.W., Gabrielli A., Hoffmann-Vold A.-M., Kuwana M., Allanore Y., Distler O.

Publicada: 1 ene 2022
Resumen:
Objectives Tocilizumab showed trends for improving skin fibrosis and prevented progression of lung fibrosis in systemic sclerosis (SSc) in randomised controlled clinical trials. We aimed to assess safety and effectiveness of tocilizumab in a real-life setting using the European Scleroderma Trial and Research (EUSTAR) database. Methods Patients with SSc fulfilling the American College of Rheumatology (ACR)/EULAR 2013 classification criteria, with baseline and follow-up visits at 12±3 months, receiving tocilizumab or standard of care as the control group, were selected. Propensity score matching was applied. Primary endpoints were the modified Rodnan skin score (mRSS) and FVC at 12±3 months compared between the groups. Secondary endpoints were the percentage of progressive/regressive patients for skin and lung at 12±3 months. Results Ninety-three patients with SSc treated with tocilizumab and 3180 patients with SSc with standard of care fulfilled the inclusion criteria. Comparison between groups did not show significant differences, but favoured tocilizumab across all predefined primary and secondary endpoints: mRSS was lower in the tocilizumab group (difference -1.0, 95% CI -3.7 to 1.8, p=0.48). Similarly, FVC % predicted was higher in the tocilizumab group (difference 1.5 (-6.1 to 9.1), p=0.70). The percentage of progressive/regressive patients favoured tocilizumab over controls. These results were robust regarding the sensitivity analyses. Safety analysis confirmed previously reported adverse event profiles. Conclusion Although this large, observational, controlled, real-life EUSTAR study did not show significant effectiveness of tocilizumab on skin and lung fibrosis, the consistency of direction of all predefined endpoints generates hypothesis for potential effectiveness in a broader SSc population. ©

Filiaciones:
Kuster S.:
 Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

Jordan S.:
 Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

Elhai M.:
 Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

 Department of Rheumatology, Paris Descartes University, Cochin Hospital, Aphp, Paris, France

Held U.:
 Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland

Steigmiller K.:
 Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland

Bruni C.:
 Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

 Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy

Cacciapaglia F.:
 Rheumatology Unit, Deto, University Hospital Polyclinic of Bari, Bari, Italy

Vettori S.:
 Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy

Siegert E.:
 Clinic for Rheumatology and Immunology, Bad Bramstedt, Germany

 Berlin Institute of Health at Charité, Berlin, Germany

Rednic S.:
 Clinica Reumatologie, University of Medicine and Pharmacy, Cluj-Napoca, Romania

Codullo V.:
 Department of Rheumatology, Irccs Foundation Policlinico San Matteo, Pavia, Italy

Airo P.:
 Uoc Rheumatology and Clinical Immunology, Spedali Civili di Brescia, Brescia, Italy

Braun-Moscovici Y.:
 B. Shine Department of Rheumatology, Rambam Health Care Campus and Technion, Haifa, Israel

Hunzelmann N.:
 University of Cologne, Cologne, Germany

Joao Salvador M.:
 Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Riccieri V.:
 Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy

Gheorghiu A.-M.:
 Department of Internal Medicine and Rheumatology, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Alegre Sancho J.J.:
 Department of Rheumatology, Hospital Peset, Valencia, Spain

Romanowska-Prochnicka K.:
 Department of Biophysics, Physiology and Pathophysiology, Medical University of Warsaw, Warsaw, Poland

 Department of Connective Tissues Diseases, Institute of Rheumatology, Warsaw, Poland

Castellví I.:
 Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

Kötter I.:
 Clinic for Rheumatology and Immunology, Bad Bramstedt, Germany

 University Hospital Hamburg-Eppendorf, Division of Rheumatology and Systemic Inflammatory Diseases, Hamburg, Germany

Truchetet M.-E.:
 Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

López-Longo F.J.:
 Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Hopital Pellegrin, Bordeaux, France

Novikov P.I.:
 Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Hopital Pellegrin, Bordeaux, France

Giollo A.:
 Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy

Shirai Y.:
 Department of Allergy and Rheumatology, Nippon Medical School, Tokyo, Japan

Belloli L.:
 Rheumatology Unit, Asst Grande Ospedale Metropolitano Niguarda, Milano, Italy

Zanatta E.:
 Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy

Hachulla E.:
 Referral Centre for Rare Systemic Auto-immune Diseases for North and North-West of France, Department of Internal Medicine, Claude Huriez Hospital, University of Lille, Lille, France

Smith V.:
 Department of Internal Medicine, Department of Rheumatology, Ghent University Hospital, Ghent, Belgium

 Unit for Molecular Immunology and Inflammation, Vib Inflammation Research Centre (IRC), Ghent, Belgium

Denton C.:
 Centre for Rheumatology, University College London Medical School, Royal Free Campus, London, United Kingdom

Ionescu R.M.:
 Internal Medicine and Rheumatology Department, St. Maria Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Schmeiser T.:
 Krankenhaus St. Josef, Elberfeld, Wuppertal, Germany

Distler J.H.W.:
 Department of Internal Medicine Iii, Erlangen University Hospital, Erlangen, Germany

Gabrielli A.:
 Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica Delle Marche, Ancona, Italy

Hoffmann-Vold A.-M.:
 Department of Rheumatology, Rikshospitalet University Hospital Oslo, Oslo, Norway

Kuwana M.:
 Department of Allergy and Rheumatology, Nippon Medical School, Tokyo, Japan

Allanore Y.:
 Department of Rheumatology, Paris Descartes University, Cochin Hospital, Aphp, Paris, France

Distler O.:
 Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
ISSN: 20565933
Editorial
BMJ PUBLISHING GROUP, BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND, Reino Unido
Tipo de documento: Article
Volumen: 8 Número: 2
Páginas:
WOS Id: 000924574100003
ID de PubMed: 36328401
imagen All Open Access, Gold

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