Tocilizumab as Effective as Placebo for Pain Relief in Hand Osteoarthritis

Tocilizumab was found to be as effective as placebo for pain relief in patients with hand osteoarthritis (OA), according to study results published in Annals of the Rheumatic Diseases. Researchers noted that patients who received tocilizumab did not experience significantly greater pain relief than those who received placebo.

Investigators aimed to assess the efficacy of tocilizumab, an antibody against the interleukin (IL)-6 receptor, in reducing pain in patients with symptomatic hand OA. They conducted a randomized, double-blind, placebo-controlled study (ClinicalTrials.gov Identifier: NCT02477059) of patients with hand OA at 11 centers in France. Eligible patients were aged between 40 and 85 years; met the American College of Rheumatology (ACR) criteria for hand OA; had at least 3 painful proximal interphalangeal or distal interphalangeal joints for more than 3 months; and had not experienced pain relief with acetaminophen, weak opioids, or nonsteroidal anti-inflammatory drugs (NSAIDs). Patients were randomly assigned 1:1 to receive 2 intravenous infusions of placebo or tocilizumab (8 mg/kg) at a 4-week interval. The primary outcome was change in pain at week 6, rated using a 0 to 100 mm visual analog scale (VAS). Adverse events were assessed throughout the trial.

Between November 2015 and October 2018, a total of 45 and 46 patients were randomly assigned to receive tocilizumab and placebo, respectively. Of these, 40 (88%) in the tocilizumab group and 39 (84%) in the placebo group completed the 12-week study. Mean participant age was 64.4 (SD, 8.7) years and 82% were women. Baseline characteristics were comparable between the treatment and placebo groups.

Mean change from baseline to week 6 in VAS pain was -7.9 (SD, 19.4) and -9.9 (SD, 20.1) in the tocilizumab and placebo groups, respectively (P =.7). The 2 groups also did not differ with regard to morning stiffness, joint pain, joint swelling, and physical functioning at weeks 6 or 12. Similarities between the treatment and placebo groups persisted in analyses stratified by synovitis and by the presence of knee OA. Adverse events were reported by 29 (69.0%) patients in the tocilizumab group compared with 22 (53.7%) in the placebo group. The most frequent adverse events in the treatment group were infections (28.6%) and neutropenia (4.9%).

Overall, study results do not support the efficacy of tocilizumab over placebo to alleviate pain and improve function in hand OA.

The primary study limitation was the short study period; a greater number of injections may have increased the effects of tocilizumab. However, prior research has indicated that 2 injections are sufficient to fully block the IL-6 signaling pathway.

 “[T]argeting IL-6 signalling may be ineffective to improve symptoms in hand OA,” the investigators wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Richette P, Latourte A, Sellam J, et al. Efficacy of tocilizumab in patients with hand osteoarthritis: double blind, randomised, placebo-controlled, multicentre trial. Ann Rheum Dis. Published online October 14, 2020. doi:10.1136/annrheumdis-2020-218547