USPOREDBA UČINKOVITOSTI TOCILIZUMABA I INHIBITORA TNF-α U LIJEČENJU REUMATOIDNOG ARTRITISA

Felina Anić, Marcela Bašić, Tatjana Zekić, Mladen Defranceschi, Srđan Novak

Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune disease. The main role in the pathogenesis of RA is played by interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α). The objectives of this study were to compare the efficacy of tocilizumab and TNF-α inhibitors in RA patients who did not receive previous biological therapy, to determine how parameters of inflammation changed within each group and between the two groups, and to analyze drug retention rates aft er 18 months of treatment. The research included 26 patients (10 tocilizumab, 16 TNF-α  inhibitors) who started biological therapy in the period between January 2011 and June 2015 and were followed for 18 months. The recorded parameters were C-reactive protein (CRP), the Disease Activity Score 28 (DAS 28 score), and the number of tender and swollen joints. Aft er 3 months of treatment the DAS 28 score was significantly lower in patients treated with tocilizumab compared with patients treated with TNF-α inhibitors (P=0.009). In both patient groups the number of tender joints was significantly reduced. In patients treated with tocilizumab the number of swollen joints was significantly reduced aft er 3 months of tocilizumab treatment, while in patients treated with TNF-α inhibitors this change was not observed. Th e mean values of CRP in both groups did not differ significantly during the study period. In the patients treated with tocilizumab there was no discontinuation of treatment, while in patients treated with TNFα inhibitors therapy was interrupted in 7 patients (44%). Remission in RA patients occurred as soon as 3 months aft er tocilizumab treatment, while in patients treated with TNF-α inhibitors it occurred within a period of 3 to 6 months.

Reumatoidni artritis (RA) kronična je, progresivna, autoimunosna upalna bolest. Glavnu ulogu u patogenezi RA imaju interleukin 6 (IL-6) i čimbenik tumorske nekroze alfa (TNF-α). Ciljevi rada bili su: usporediti učinak tocilizumaba i inhibitora TNF-α u bolesnika s RA koji prije nisu primali biološku terapiju, ustanoviti kako se mijenjaju parametri upale u svakoj skupini i jednoj naspram drugoj te analizirati stopu ostanka na biološkoj terapiji nakon 18 mjeseci. Istraživanje je provedeno na 26 ispitanika (10 tocilizumab, 16 inhibitor TNF-α) koji su započeli biološku terapiju u razdoblju od siječnja 2011. do lipnja 2015. i praćeni su 18 mjeseci. Bilježeni parametri jesu: C-reaktivni protein (CRP), indeks aktivnosti bolesti (engl. Disease Activity Score 28 – DAS 28), broj bolnih i otečenih zglobova. Nakon 3 mjeseca terapije zbroj DAS 28 bio je znatno niži u bolesnika liječenih tocilizumabom nego u onih liječenih inhibitorima TNF-α (P = 0,009). U obje skupine ispitanika zabilježeno je statistički značajno smanjenje broja bolnih zglobova. U bolesnika liječenih tocilizumabom već je nakon tri mjeseca došlo do statistički značajnog smanjenja broja otečenih zglobova, za razliku od bolesnika liječenih inhibitorima TNF-α u kojih nije zabilježeno to smanjenje. Srednje vrijednosti CRP-a u ispitanika obiju skupina nisu se znatno razlikovale za svako ispitivano razdoblje. Kod bolesnika na tocilizumabu nije zabilježen prekid biološke terapije, dok se u liječenih inhibitorima TNF-α liječenje prekinulo u 7 bolesnika (44%). Pojava remisije u bolesnika s RA uslijedila je već nakon 3 mjeseca terapije tocilizumabom, a kod bolesnika na inhibitorima TNF-α u razdoblju između 3 i 6 mjeseci.