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Introduction Tocilizumab (TCZ) has demonstrated a positive impact on interstitial lung disease (ILD) and potential benefits on skin fibrosis in systemic sclerosis (SSc). This study aims to evaluate the safety and effectiveness of TCZ in a real-life setting, on skin and lung involvements but also other complications, using data from a French-Italian multicenter cohort.Material and Methods A longitudinal retrospective analysis was conducted on SSc patients, treated with TCZ among 15 referral centres. Data were collected at 12 months prior to TCZ introduction, at baseline, at 12 and 24 months after TCZ. Parameters assessed included: modified Rodnan skin score (mRSS), pulmonary function tests, joint Disease Activity Score (DAS28-CRP), cardiovascular domains were investigated using digital ulcer counts, cardiac biomarkers and heart ejection fraction (EF). Lung progression was defined as an absolute drop in predicted forced vital capacity (pFVC) >= 5% over a 12 ± 3 months period of time.Results 197 patients, 88% female, median age 57 (46-69) years, median disease duration 9 (4-15) years, were included; 67% were ATA positive. 52(29%) were on TCZ monotherapy, the most common combination therapy was with methotrexate(35%). In SSc-ILD patients, a significant decline of %pFVC from 12 months prior to TCZ(81 ± 21) to baseline(77 ± 22; p=0.003) was observed. . Upon TCZ, a stabilization of %pFVC was observed at 12 months, progressors dropped from 43% to 24%,p=0.015. Improvement in %pFVC was observed at 24 months(p=0.005). Among dcSSc, a significant reduction in mRSS was observed at month 12 and 24(p <0.001). The percentage of patients with digital ulcers significantly reduced over the 24 months(p=0.001). In patients with arthritis, DAS28-CRP showed a significant decline both at month 12 and 24. Among patients with myocardial involvement, troponin levels reduced over time, together with a stabilization in NT-proBNP. Infections were the most common adverse effects (22.8%). Treatment was suspended in 63 patients (32%) after a median time of 8(4-22) months, the main reason being inefficacy(41%). The presence of PAH(OR 4.01, 1.20-13.38) and older age were associated with TCZ failure, while elevated C-reactive protein(OR 0.34, 0.11-0.99) associated with a better response.Conclusions Our real-life data support the use of tocilizumab in SSc. TCZ was commonly used in combination with other immunosuppressive drugs. We report consistent beneficial effects on lung and skin involvements and extend the effects to peripheral vasculopathy and arthritis. This raise the potential of TCZ to act as a disease modifier thanks to multiple effects, while the costs for safety were limited.