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
All Open Access, Gold
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