Key result
Tocilizumab treatment for 24 weeks in rheumatoid arthritis patients resulted in the loss of baseline correlations between ultrasound global scores and serum inflammatory cytokines, despite clinical and ultrasound score improvements.
Why the study?
Correlation between ultrasound-based joint assessment and serum cytokines was validated in cross-sectional but not prospective studies.
Does ultrasound global score reliably reflect serum inflammatory cytokine status during tocilizumab treatment in RA patients?
Observational (n=24)
Single-blind
No
Does ultrasound global score reliably reflect serum inflammatory cytokine status during tocilizumab treatment in RA patients?
Ultrasound global score is not a reliable surrogate marker for inflammatory cytokine status during tocilizumab treatment in RA patients.
Ultrasound scores may not surrogate cytokine status on tocilizumab; leaves open optimal RA monitoring strategies.
Background Rheumatoid arthritis (RA) is characterized by persistent synovitis, which is evaluated using ultrasound. Ultrasound-based global assessment of the joints is correlated with serum cytokine levels. This correlation was validated in cross-sectional but not in prospective studies. We aimed to verify this validity in a prospective study of RA patients treated with the interleukin (IL)-6 receptor inhibitor tocilizumab. Methods Twenty-four consecutive RA patients started on tocilizumab treatment were prospectively enrolled. Serum levels of 27 cytokines/chemokines were measured using a multiplex immunoassay (Bio-Plex assay). Clinical examination and comprehensive ultrasound assessment of joints were conducted at baseline and 24 weeks. Results Clinical and ultrasound global scores showed significant improvements at 24 weeks (Disease Activity Score 28-joint count-erythrocyte sedimentation rate: p = 0.001, ultrasound power Doppler global score with 40 joints [PD40]: p = 0.028); however, there was no significant improvement in the inflammatory cytokine levels (IL-6: p = 0.93, vascular endothelial growth factor [VEGF]: p = 0.79, tumor necrosis factor [TNF]: p = 0.85). Before tocilizumab introduction, PD40 showed a significant correlation with multiple serum cytokines, including IL-6 (r = 0.584, p = 0.045), VEGF (r = 0.582, p = 0.047), TNF-α (r = 0.695, p = 0.012), and interferon gamma-induced protein-10 [IP-10] (r = 0.827, p = 0.001); this correlation was lost after 24 weeks. IL-6-associated cytokines (IL-8, IP-10, monocyte chemoattractant protein-1, macrophage inflammatory protein-1a) and growth factors (VEGF, platelet-derived growth factor-bb, fibroblast growth factor-basic) altered > 50% of the correlated partner-cytokines after tocilizumab introduction. Conclusions The ultrasound global score is not a reliable surrogate marker of multiple inflammatory cytokine statuses during tocilizumab treatment. Thus, it should not be a rationale to determine tocilizumab discontinuation in RA patients.
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Ogasawara et al. (2023) conducted an observational in Rheumatoid arthritis (n=24). Tocilizumab vs. Baseline (pre-treatment) was evaluated on Correlation between ultrasound global score (PD40) and serum inflammatory cytokines at 24 weeks. Tocilizumab treatment for 24 weeks in rheumatoid arthritis patients resulted in the loss of baseline correlations between ultrasound global scores and serum inflammatory cytokines, despite clinical and ultrasound score improvements.
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