Tocilizumab strikes out in hand osteoarthritis

Interleukin (IL)-6 blockade with tocilizumab is only as good as placebo at easing pain in patients with hand osteoarthritis, a study has found.

In total, 104 patients (mean age, 64.4 years; 82 percent female) with symptomatic hand osteoarthritis were randomized to receive two infusions of either tocilizumab (8 mg/kg intravenous; n=45) or placebo (n=46), administered 4 weeks apart (weeks 0 and 4).

The patients reported having pain of ≥40 on a 0–100 mm visual analogue scale (VAS) despite taking analgesics and nonsteroidal anti-inflammatory drugs. They also had at least three painful joints, with Kellgren-Lawrence grade ≥2. Baseline characteristics were similar in the two treatment groups, except for body mass index, which was lower in the tocilizumab group (23.1 vs 25.7 kg/m²).

Seventy-nine patients completed the 12-week study. Tocilizumab did not produce a significant reduction in the primary endpoint of VAS at week 6 compared with placebo (−7.9 vs −9.9, respectively; p=0.7).

The same was true for the secondary outcomes including the number of painful and swollen joints, duration of morning stiffness, patients’ and physicians’ global assessment, and function scores. There was no significant between-group difference observed in all these parameters at all time points (weeks 4, 6, 8, and 12).

In terms of safety, adverse events occurred slightly more frequently in the tocilizumab than placebo group (69.0 percent vs 53.7 percent). The most common events among patients who were actively treated were infections (28.6 percent) and neutropaenia (4.9 percent).

The findings suggest that targeting IL-6 signalling may not be an effective strategy to improve symptoms in hand osteoarthritis.