Tocilizumab Improves Inflammatory Anemia in RA

Isaacs JD, Harari O, Kobold U, et al. Effect of tocilizumab on haematological markers implicates interleukin-6 signalling in the anaemia of rheumatoid arthritis. Arthritis Research & Therapy (2013) 15:R204 doi:10.1186/ar4397. (Open access)

Tocilizumab (Actemra) appears to dampen inflammation, increase hemoglobin, and improve inflammatory anemia in rheumatoid arthritis (RA), judging from  post hoc analysis of a randomized late-stage clinical trial.

The multi-center British stage 3B trial randomized 132 patients with moderate to severe RA to receive either tocilizumab 8 mg/kg intravenously (n=69) or placebo (n=63) every four weeks plus weekly methotrexate (MTX) for 24 weeks. Most subjects were women, the median age was 57, and all had a history of inadequate  response to MTX.

At baseline, 7.1% of the tocilizumab and 11.3% of placebo patients had anemia, defined as hemoglobin below 11 g/dl for women, under 12 g/dl for men. Tocilizumab, an interleukin-6 (IL-6) inhibitor, is a logical choice for these patients because anemia in RA is thought to be triggered by IL-6, which is known to increase C-reactive protein (CRP) and reduce iron transport and hemoglobin.

In the study, tocilizumab immediately reduced CRP and the iron metabolism marker hepcidin and gradually increased hemoglobin, improving anemia in 70 patients. The placebo group showed no such effects.

The decline in hepcidin appeared within the first week or two, and hemoglobin began to increase at 4 weeks, continuing to rise to week 12. Again, there were no effects for placebo.

The researchers stress that a post hoc analysis of this kind can suggest causal effects, but cannot assess them.

Disclosures:

Tocilizumab (Actemra) appears to dampen inflammation, increase hemoglobin, and improve inflammatory anemia in rheumatoid arthritis (RA), judging from  post hoc analysis of a randomized late-stage clinical trial.