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AB0549 Discontinuation of methotrexate (MTX) in rheuamtoid arthritis (RA) patients receiving tocilizumab (TCZ)
  1. K. Nishimura,
  2. R. Sakai,
  3. T. Kondo,
  4. T. Kurasawa,
  5. A. Okuyama,
  6. E. Nishi,
  7. Y. Shirai,
  8. H. Takei,
  9. H. Nagasawa,
  10. K. Amano
  1. Department of Rheuatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan

Abstract

Background Although MTX is the anchor drug for the managemant of RA because of its effectiveness and affordability, some patients taking MTX develop liver dysfunction, nausea and bone marrow suppression. In addition, a few patients treated with MTX have life-threatening interstitial pneumonitis and lymphoproliferative disorders that may possibly progress to lymphoma if MTX is continued.

TCZ is the only biological agent that has the evidence of efficacy for RA without concomitant MTX based on the clinical studies. This will suggest that MTX can be discontinued in some patients with RA treated with TCZ successfully.

Objectives To clarify clinical characteristics of RA patients who were able to quit taking MTX within 52 weeks after the start of TCZ.

Methods Clinical records of 89 RA patients (11 males, 78 females) in whom TCZ was newly initiated with MTX in our institute were retrospectively reviewed.

Results MTX was discontinued in 23 of 89 patients(26%). Background of the MTX-discontinued group (n=23) and the MTX-continued group (n=66) at the start of TCZ, mean age was 62.2 and 56.3 years old (p<o.o5), mean disease duration was 119 and 120 months (n.s.), mean MTX dose was 7.0 and 7.8 mg/week (n.s.), mean DAS28-ESR was 6.20 and 5.50 (p<o.o5), respectively. At week 52 in the MTX-discontinued group and in the MTX-continued group, mean DAS28-ESR was 2.87 and 2.80(n.s.), CDAI was improved from 28.6 to 9.5 and from 24.6 to 10.7, CDAI remission ratio was 26% and 21%, HAQ-DI was reduced from 1.68 to 1.10 and from 1.47 to 1.16, respectively. All these values were not significant between 2 groups.

Conclusions MTX was discontinued more frequently in the elderly patients possibly due to considering patients’ safety by their attending doctors, which may be good for the prevention of previously mentioned MTX-induced adverse events. In addition, though MTX-discontinued group patients had higher disease activity, TCZ was equally effective as MTX-continued group patients. TCZ mono-therapy seems to be useful to maintain the low disease activity. It might be recommended to stop MTX after achieving low disease activity or remission with tocilizumab in RA patients, especially elders.

Disclosure of Interest K. Nishimura Grant/Research support from: Chugai Pharma, R. Sakai Grant/Research support from: Chugai Pharma, T. Kondo Grant/Research support from: Chugai Pharma, T. Kurasawa Grant/Research support from: Chugai Pharma, A. Okuyama Grant/Research support from: Chugai Pharma, E. Nishi Grant/Research support from: Chugai Pharma, Y. Shirai Grant/Research support from: Chugai Pharma, H. Takei Grant/Research support from: Chugai Pharma, H. Nagasawa Grant/Research support from: Chugai Pharma, K. Amano Grant/Research support from: Chugai Pharma

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