Tocilizumab effective in refractory joint, skin involvement in systemic sclerosis

Interleukin-6 inhibition by tocilizumab (TCZ) leads to improvements in refractory joint and skin involvement regardless of systemic sclerosis (SSc) disease duration or subtype, reports a study.

The authors prospectively monitored 21 patients (mean age 52 years, 20 women, 16 diffuse cutaneous SSc, 10 with early disease [<5 years], and 11 with long-standing disease [mean disease duration 6.4 years) with active joint or skin involvement refractory to corticosteroids (n=21), methotrexate (n=19), cyclophosphamide (n=10), mycophenolate mofetil (n=7), rituximab (n=1), leflunomide (n=2), hydroxychloroquine (n=2), and haematopoietic stem cell transplantation (n=2) who received weekly TCZ (162 mg subcutaneously) in an academic centre.

Analyses were conducted for changes in modified Rodnan skin score (mRSS), Disease Activity Score in 28 joints (DAS28), lung function tests (LFTs), and patient-reported outcomes (PROs) after 1 year of treatment and at end of follow-up.

One patient stopped using TCZ after 3 months due to inefficacy. Improvement was observed in the remaining 20 patients during the first year of treatment: skin involvement (mean mRSS change, –6.9; p<0.001), polyarthritis (mean DAS28 change, –1.9; p<0.001), and PROs (p<0.001 for all); 16 of 20 patients had LFT stabilization.

Three patients discontinued TCZ during the second year of treatment (cytomegalovirus infection in one and inefficacy in two), and one succumbed to the disease. The benefits of TZC persisted in all 16 patients at end of follow-up (2.2 years), but three had LFT deterioration. TCZ was well tolerated, except for digital ulcer infection in three patients.

“Long-term retention rates and disease stabilization for most real-world patients suggest that TCZ might be a valuable choice for difficult-to-treat SSc,” the authors said.