Treatment with tocilizumab has been associated with an increase in

PS-­‐127: ELEVATED TRANSAMINASE LEVELS IN PATIENTS TREATED WITH TOCILIZUMAB MI GUZMÁN RAMOS 1, MJ FOBELO LOZANO 2, E. CALVO CIDONCHA 2, R. CANTUDO CUENCA 2, M. GARCIA MANZANO 2, A. ROBUSTILLO CORTÉS 2, E. ALVARO SANZ 3, Á. Tristancho PÉREZ 2, E. GÓMEZ FERNÁNDEZ 2, C. ARO MÁRQUEZ 2. 1 Hospital Universitario de Valme, FARMACIA, Sevilla, España. 2 HU NUESTRA SEÑORA DE VALME, FARMACIA, SEVILLA, España. 3 HOSPITAL COSTA DEL SOL, FARMACIA, MARBELLA, España. Background: Treatment with tocilizumab has been associated with an increase in transaminase levels which may be related with disconXnuaXon treatment. Objec>ves: To examine changes of transaminase levels (AST/ALT) in paXents with rheumaXc diseases treated with tocilizumab, as well as analyze the control intervenXons. Material and methods: RetrospecXve observaXonal study. PaXents in treatment with tocilizumab between January-­‐2007/July-­‐2014 were included. The data collected were: demographic, diagnosis, duraXon and pagern dosage of treatment, AST/ALT levels and concomitant treatment with methotrexate. The data were collected through outpaXent electronic medical records. Results: We included 21 paXents (86% male, 45.6±13.8 years). 71% of paXents had rheumatoid arthriXs. The mean treatment duraXon was 24.4±15.8 months. Transaminase levels aLer the start of treatment with tocilizumab 140% 120% 48% pa>ents < ULN 100% 52% pa>ents > ULN Pa>entes 36% who received methotrexate 80% When the altera>on occurs? The increase of AST/ALT levels occurred in 73% of pa>ents between the 1ª and 3ª doses of treatment. 60% 40% The results reached values of: 20% 0% 100% 18% 3-­‐5 Xmes >ULN 82% 1-­‐3 Xmes >ULN 80% Interven>ons: 27.27% • In 100% of pa>ents: doses=8 mg/kg • 50% of pa>ents was also on methotrexate treatment 60% 40% 20% 72.73% In 3 pa>ents (27.27%) pharmacological interven>on took place 0% 66,67
% effec>ve interven>on The interven>ons were: decrease tocilizumab dose (in 2 pa>ents) decresase both the dose of tocilizumab and methotrexate (in 1 pa>ents) Conclusions: Half of paXents treated with tocilizumab suffer an increase in AST/ALT levels, which in most cases is maintained over Xme. The concomitant treatment with methotrexate seems to predispose an earlier increase of transaminase levels. Tocilizumab risk management should include conXnuous monitoring of transaminase levels for idenXfying paXents with a higher risk.