Background Tocilizumab (TCZ) is a biological product approved as a treatment for rheumatoid arthritis. The REACTION 52-week study reported that baseline HAQ is a predictive factor of clinical, functional and structural remission at one year of treatment.
Objectives To investigate clinical and functional remission rates at Week 24 of TCZ treatment for rheumatoid arthritis as well as factors that contribute to the achievement of clinical and functional remission.
Methods This study evaluated 40 patients followed up for at least 24 weeks after the initiation of TCZ treatment. Patient demographic data: mean age, 62.9±11.7years; mean disease duration, 10.8±11.9years; CDAI, 19.6±11.7; m-HAQ, 0.6±0.6; concomitant use of MTX, 75% (30/40); mean MTX dose, 7.4±2.2 mg/week; and prior use of TNF inhibitors, 40% (16/40). CDAI and m-HAQ were used to evaluate clinical and functional efficacy (LOCF method), and factors that contribute to clinical and functional remission at Week 24 were also investigated.
Results At Week 24, tocilizumab were continued in 34 patients (85.0%). One patient had discontinued tocilizumab because of diverticular hemorrhage. No other serious adverse events were observed. CDAI was significantly improved to 6.3±8.1 (P<0.01), with a clinical remission rate (CDAI≤2.8) of 47.5% and a Boolean remission rate of 40.0%. At Week 24, m-HAQ was significantly improved to 0.4±0.5 (P<0.05), with a functional remission rate (m-HAQ≤0.5) of 67.5%. The clinical and functional remission rate (CDAI≤2.8 + m-HAQ≤0.5) at Week 24 was 40.0%, and the factors that contribute to this rate identified by univariate analysis included: younger age at baseline (P<0.01), lower patient global VAS scores (P<0.05), lower m-HAQ (P<0.05), achievement of DAS-28-ESR remission at Week 12 (P<0.05), and achievement of Boolean remission at Weeks 4 and 12 (P<0.05 and P<0.01, respectively).
Conclusions This study suggests that early introduction of TCZ before worsening of functional disorder is necessary to achieve good outcomes at Week 24 of TCZ treatment. Favorable treatment response up to Week 12 is considered to be a predictive factor of good outcomes.
T.Takeuchi et.al, Clinical,radiographic and functional effectiveness of tocilizumab for rheumatoid arthritis patients-REACTION 52-week study. Rheumatology 2011.50(10):1908-15
Disclosure of Interest None Declared