J Rheum Dis.  2016 Feb;23(1):37-46. 10.4078/jrd.2016.23.1.37.

Clinical and Hematological Effects of Tocilizumab on Serum Hepcidin, Anemia Response and Disease Activity in Patients with Active Rheumatoid Arthritis

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea. parkyw@jnu.ac.kr
  • 2Department Laboratory Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.

Abstract


OBJECTIVE
The purpose of this study is to evaluate the clinical and hematological effects of tocilizumab in active rheumatoid arthritis (RA) patients.
METHODS
Fourteen patients with active RA were enrolled in this study. The patients received tocilizumab 8 mg/kg intravenously every four weeks for 6 months. Disease activity, anemia-related factors including serum hepcidin-25, and hematological parameters were monitored at baseline and at 1, 3, and 6 months after the initiation of treatment.
RESULTS
Significant reductions in tender joint count, swollen joint count, visual analogue scale, erythrocyte sedimentation rate (ESR), and C-reactive (CRP) protein plus reductions in a 28-joint disease activity score were observed within one month after the first tocilizumab treatment. These effects lasted throughout the six-month study period. In addition, significant improvements in anemia-related factors such as hepcidin-25, ferritin, iron, hemoglobin, red blood cell counts and mean corpuscular volume were observed during the treatment period. Hematological parameters were improved with reductions in counts for leukocytes, monocytes, neutrophils, and platelets. The lymphocyte counts and their subset numbers were unchanged. Changes in hepcidin levels showed significant correlation with changes in CRP, ESR, ferritin, hemoglobin and counts for red blood cells, leukocytes, and neutrophils during the treatment period.
CONCLUSION
This study demonstrates that tocilizumab significantly and meaningfully reduces disease burden in patients with active RA. In addition, tocilizumab diminishes the levels of inflammatory anemia by inhibiting hepcidin production. These clinical data provide evidence of a favorable outcome from tocilizumab in RA.

Keyword

Rheumatoid arthritis; Tocilizumab; Hepcidins; Anemia; Disease activity

MeSH Terms

Anemia*
Arthritis, Rheumatoid*
Blood Sedimentation
Erythrocyte Count
Erythrocyte Indices
Erythrocytes
Ferritins
Hepcidins*
Humans
Iron
Joints
Leukocytes
Lymphocyte Count
Monocytes
Neutrophils
Ferritins
Iron
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