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FRI0142 The comparison of the ultrasonographic synovial findings between intravenous administration and subcutaneous injection of tocilizumab

Background Biologic disease-modifying anti-rheumatic drugs (bDMARDs) that target cytokines and cytokine receptors such as tumour necrosis factor (TNF) alpha and interleukin (IL) 6 have been established as a standard therapy in patients with rheumatoid arthritis (RA). Tocilizumab (TCZ) that targets IL-6 receptors has two administration routes such as intravenous administration (IV) or subcutaneous injection (SC). The effect of TCZ-SC therapy demonstrated comparable efficacy and safety to TCZ-IV therapy in clinical study.1, 2 However, there have been no reports that evaluate the effect of TCZ-IV and SC for synovitis by imaging modality. Objectives The aim of this study was to compare the ultrasound findings between patients with rheumatoid arthritis (RA) treated by TCZ-IV and SC. Methods All patients with RA who treated with TCZ in Osaka City University RA registry (1140 patients with RA and 390 patients using bDMARDs) were included in this cross-sectional study. US examination was performed in MCP, PIP, wrist and MTP joints and finger flexor tendon and wrist extensor tendon, by using HI VISION Ascendus (Hitachi Medical Corporation, Japan) with a multifrequency linear transducer (18–6 MHz). The grey scale (GS) and power Doppler (PD) findings were assessed by the semi-quantitative method (0–3). GS score and PD score (both 0–156 points) were defined as the sum total of each score. Results We analysed total 76 patients who treated TCZ, 27 patients in IV group and 49 patients in SC group (mean age: 62.9±14.0 vs 66.0±13.2 years, p=0.343, mean duration of RA: 17.1±11.1 vs 13.7±12.3 years, p=0.218). The duration of TCZ use was significantly longer in IV (4.6±2.2 vs 3.0±2.4 years, p=0.004). Clinically, DAS28-ESR improved from 5.3±1.5 at baseline to 2.4±1.1 at US examination in IV group, and it improved from 5.2±1.4 to 2.8±1.5 in SC group. US findings were not significantly differenced in both groups, GS score: 11.7±12.5 vs 10.9±9.6 (p=0.751), PD score: 5.3±8.1 vs 5.7±6.8 (p=0.832), max PD grade: 1.3±0.9 vs 1.4±0.9 (p=0.571) in IV and SC respectively.Abstract FRI0142 – Table 1 The comparison of demographic and ultrasonographic findings between TCZ-IV and SC patients with rheumatoid arthritis. TCZ-IV group(n=27) TCZ-SC group(n=49) P value Age (years old) 62.9±14.0 66.0±13.2 0.343 Disease duration (years) 17.1±11.1 13.7±12.3 0.218 Duration of TCZ use (years) 4.6±2.2 3.0±2.4 0.004 DAS28-ESR at baseline 5.3±1.5 5.2±1.4 0.780 DAS28-ESR at ultrasound examination 2.4±1.1 2.8±1.5 0.175 CDAI at baseline 21.8±14.5 22.8±14.4 0.787 CDAI at ultrasound examination 7.3±5.9 10.6±10.4 0.082 Total GSUS score 11.7±12.5 10.9±9.6 0.751 Total PDUS score 5.3±8.1 5.7±6.8 0.832 Maximum PDUS grade 1.3±0.9 1.4±0.9 0.571 Conclusions We compared the ultrasound findings between patients with RA treated by TCZ-IV and SC. Ultrasound findings between IV and SC were not significantly differenced. Both administration routes of TCZ are effective for the treatment in patients with RA. References [1] Ogata A, Tanimura K, Sugimoto T, et al. Arthritis Care Res. 2014;66:344–54. [2] Burmester GR, Rubbert-Roth A, Cantagrel A, et al. Ann Rheum Dis. 2014;73:69–74. Acknowledgements We wish to thank Tomoko Nakatsuka for clinical assistant, Setsuko Takeda, Emi Yamashita and Yuko Yoshida for their special efforts as a sonographer and collecting data. Disclosure of Interest None declared