BACKGROUND: Anakinra, an interleukin-1 receptor antagonist and tocilizumab, an 
interleukin-6 receptor blocker, are used for the treatment of rheumatoid 
arthritis. We investigated the differential effects of anakinra and tocilizumab 
on myocardial and vascular function in an atherosclerosis model of patients with 
rheumatoid arthritis.
METHODS: 120 patients with rheumatoid arthritis were randomized to anakinra 
(n = 40), tocilizumab (n = 40) or prednisolone (n = 40) for 3 months. Primary 
outcome measure was the change of left ventricular longitudinal strain after 
3 months of treatment. Additionally, we measured coronary flow reserve, 
flow-mediated dilatation of the brachial artery, carotid-femoral pulse wave 
velocity, malondialdehyde and protein carbonyls as oxidative stress markers and 
C-reactive protein blood levels at baseline and post-treatment.
RESULTS: At baseline, patients among the three treatment arms had similar age, 
sex, disease activity score and atherosclerotic risk factors. Compared with 
baseline, all patients had improved longitudinal strain (- 16% vs. - 17.8%), 
coronary flow reserve (2.56 vs. 2.9), malondialdehyde (2.0 vs. 1.5 µM/L), 
protein carbonyls (0.0132 vs. 0.0115 nmol/mg), and C-reactive protein 
post-treatment. In all patients, the percent decrease of malondialdehyde was 
correlated with percent increase of longitudinal strain (p < 0.001). Compared 
with tocilizumab and prednisolone, anakinra treatment resulted in a greater 
improvement of longitudinal strain (18.7% vs. 9.7% vs. 6%) and coronary flow 
reserve (29% vs. 13% vs. 1%), while pulse wave velocity and brachial blood 
pressure were improved only after tocilizumab treatment (11 ± 3 vs. 10.3 ± 2 m/s 
p < 0.05 for all comparisons).
CONCLUSIONS: Anakinra is associated with an improvement in cardiac function and 
tocilizumab with improvement in vascular function.
CLINICAL TRIAL REGISTRATION: URL: https:// http://www.clinicaltrials.gov . 
Unique identifier: NCT03288584.