Background Tocilizumab (TCZ) is a humanised anti interleukin-6 receptor antibody licensed for use for the treatment of moderate to severe Rheumatoid Arthritis (RA) as monotherapy or in combination with methotrexate (MTX).
Objectives To describe the use of TCZ for RA in a large UK teaching centre and examine reasons for treatment discontinuation.
Methods A retrospective case note review of all adult patients receiving TCZ either alone or in combination with DMARDS, for the treatment of RA between April 2009 and January 2017 in Sheffield, UK.
Results 132 patients received TCZ for RA. 71% were female. 61% were CCP positive. Mean disease duration was 15.6 years (range 1.5–43). 46 (34.6%) received TCZ as monotherapy, 55 (42.1%) in combination with MTX and 31 (23.3%) other DMARDS. 23% of patients received concomitant oral prednisolone. Median duration of TCZ treatment was 27 months across the whole cohort, and 19 months in those who discontinued treatment.
Overall 44 (33%) patients discontinued TCZ; 5 due to primary and 10 secondary inefficacy, 27 patients due to adverse events (8 recurrent infection, 5 abnormal LFT, 4 malignancy, 3 rash, 7 other including 1 death whilst on treatment). A logistic regression model, including gender, smoking status, disease duration, DMARD use, steroid treatment and number of prior biologics was constructed to examine association with treatment discontinuation. Of these factors, disease duration (p=0.05) and number of previous biologics (p=0.09) were weakly associated with persistence of TCZ and in particular there was no association of concomitant DMARD or steroid treatment with discontinuation either due to lack of efficacy or adverse events. Table 1 demonstrates the proportion of patients stopping treatment, and treatment duration according to previous biologic treatment received. We have not seen any cases of infusion reaction, diverticular perforation or reactivation of tuberculosis.
Conclusions Our real world data on the use of TCZ in the treatment of adult patients with RA is consistent with clinical trial data for efficacy and safety and is similar to other biological drugs used in the treatment of RA. We have seen a relatively low rate of withdrawal due to primary and secondary treatment failure.
Disclosure of Interest None declared