Tocilizumab treatment in AA amyloidosis: case report and literature review
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Abstract
Introduction: AA amyloidosis can be a complication of certain chronic inflammatory disorders, although between 21% and 50% can be idiopathic. There is no specific treatment. Tocilizumab, directed against the IL-6 receptor and aimed at decreasing SAA production, could be effective.
Methods: in this study, we report data from 6 patients with AA amyloidosis treated with subcutaneous tocilizumab monotherapy between the period 2011-2018. The main endpoints were the clinical and biochemical improvement of the affected organs and the biochemical parameters markers of inflammation.
Results: the kidney was affected in all patients, manifesting with a fall in glomerular filtration rate and nephrotic syndrome. Gastrointestinal bleeding occurred in one patient and another had lung involvement on biopsy. After treatment, all improved hematocrit, serum albumin, and body mass
index. SAA decreased in 5 patients. One patient improved his kidney function, while 4 remained stable. Three patients decreased proteinuria values
Conclusion: treatment with tocilizumab could be effective in the treatment of patients with AA amyloidosis.
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Pinney JH, Smith CJ, Taube JB, et al. Systemic amyloidosis in England: an epidemiological study. Br J Haematol. 2013;161(4):525-532. https://doi.org/10.1111/bjh.12286. DOI: https://doi.org/10.1111/bjh.12286
Aguirre MA, Boietti BR, Nucifora E, et al. Incidence rate of amyloidosis in patients from a medical care program in Buenos Aires, Argentina: a prospective cohort. Amyloid. 2016 Sep;23(3):184-187. https://doi.org/10.1080/13506129.2016.1207626. DOI: https://doi.org/10.1080/13506129.2016.1207626
Bunker D, Gorevic P. AA amyloidosis: Mount Sinai experience, 1997-2012. Mt Sinai J Med. 2012 Nov-Dec;79(6):749-756. https://doi.org/10.1002/msj.21342. DOI: https://doi.org/10.1002/msj.21342
Aguirre MA, Boietti BR, Nucifora E, et al. Amiloidosis AA. Estudio de cohorte en una institución [AA amyloidosis. A single institution cohort study]. Medicina (B Aires). 2019;79(4):276-279.
Urieli-Shoval S, Linke RP, Matzner Y. Expression and function of serum amyloid A, a major acute-phase protein, in normal and disease states. Curr Opin Hematol. 2000;7(1):64-69. https://doi.org/10.1097/00062752-200001000-00012. DOI: https://doi.org/10.1097/00062752-200001000-00012
Pinney JH, Lachmann HJ. Systemic AA amyloidosis. Subcell Biochem. 2012;65:541-564. https://doi.org/10.1007/978-94-007-5416-4_20. DOI: https://doi.org/10.1007/978-94-007-5416-4_20
Westermark GT, Fändrich M, Westermark P. AA amyloidosis: pathogenesis and targeted therapy. Annu Rev Pathol. 2015;10:321-44. https://doi.org/10.1146/annurev-pathol-020712-163913. DOI: https://doi.org/10.1146/annurev-pathol-020712-163913
Lachmann HJ, Goodman HJ, Gilbertson JA, et al. Natural history and outcome in systemic AA amyloidosis. N Engl J Med. 2007;356(23):2361-2371. https://doi.org/10.1056/NEJMoa070265. DOI: https://doi.org/10.1056/NEJMoa070265
Papa R, Lachmann HJ. Secondary, AA, Amyloidosis. Rheum Dis Clin North Am. 2018;44(4):585-603. https://doi.org/10.1016/j.rdc.2018.06.004. DOI: https://doi.org/10.1016/j.rdc.2018.06.004
Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT). Disposición 7858 [Internet]. [Buenos Aires: ANMAT; 2015 sept 28] [citado 2021 oct 10]. Disponible en: http://www.anmat.gov.ar/boletin_anmat/septiembre_2015/Dispo_7858-15.pdf.
Okuda Y. AA amyloidosis - Benefits and prospects of IL-6 inhibitors. Mod Rheumatol. 2019 Mar;29(2):268-274. https://doi.org/10.1080/14397595.2018.1515145 DOI: https://doi.org/10.1080/14397595.2018.1515145
Lane T, Gillmore JD, Wechalekar AD, et al. Therapeutic blockade of interleukin-6 by tocilizumab in the management of AA amyloidosis and chronic inflammatory disorders: a case series and review of the literature. Clin Exp Rheumatol. 2015;33(6 Suppl 94):S46-S53.
Nishida S, Hagihara K, Shima Y, et al. Rapid improvement of AA amyloidosis with humanised anti-interleukin 6 receptor antibody treatment. Ann Rheum Dis. 2009;68(7):1235-6. https://doi.org/10.1136/ard.2008.099267. DOI: https://doi.org/10.1136/ard.2008.099267
Courties A, Grateau G, Philippe P, et al. AA amyloidosis treated with tocilizumab: case series and updated literature review. Amyloid. 2015;22(2):84-92. https://doi.org/10.3109/13506129.2014.1002031. DOI: https://doi.org/10.3109/13506129.2014.1002031
Ugurlu S, Hacioglu A, Adibnia Y, et al. Tocilizumab in the treatment of twelve cases with aa amyloidosis secondary to familial mediterranean fever. Orphanet J Rare Dis. 2017;12(1):105. https://doi.org/10.1186/s13023-017-0642-0. DOI: https://doi.org/10.1186/s13023-017-0642-0
Jung JY, Kim YB, Kim JW, et al. Biologic therapy for amyloid A amyloidosis secondary to rheumatoid arthritis treated with interleukin 6 therapy: Case report and review of literature. Medicine (Baltimore). 2021;100(32):e26843. https://doi.org/10.1097/MD.0000000000026843. DOI: https://doi.org/10.1097/MD.0000000000026843
Gillmore JD, Lovat LB, Persey MR, et al. Amyloid load and clinical outcome in AA amyloidosis in relation to circulating concentration of serum amyloid A protein. Lancet. 2001;358(9275):24-29. https://doi.org/10.1016/S0140-6736(00)05252-1. DOI: https://doi.org/10.1016/S0140-6736(00)05252-1