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Long-term safety and efficacy of tocilizumab, an anti-interleukin-6 receptor monoclonal antibody, in monotherapy, in patients with rheumatoid arthritis (the STREAM study): evidence of safety and efficacy in a 5-year extension study
  1. Norihiro Nishimoto (norihiro{at}
  1. Graduate School of Frontier Biosciences, Osaka University, Japan
    1. Nobuyuki Miyasaka
    1. Tokyo Medical and Dental University, Japan
      1. Kazuhiko Yamamoto
      1. University of Tokyo, Japan
        1. Shinichi Kawai
        1. Toho University School of Medicine, Japan
          1. Tsutomu Takeuchi
          1. Saitama Medical Center/Saitama Medical University, Japan
            1. Junichi Azuma (azuma{at}
            1. Osaka University, Japan


              Objectives: To evaluate the safety and efficacy of 5-year, long-term tocilizumab monotherapy for patients with rheumatoid arthritis.

              Methods: In an open-label, long-term extension trial following an initial 3-month randomised phase II trial, 143 of the 163 patients who participated in the initial blinded study received tocilizumab monotherapy (8 mg/kg) every 4 weeks. Concomitant therapy with NSAIDs and/or oral prednisolone (10 mg daily maximum) was permitted. All patients were evaluated with American College of Rheumatology (ACR) improvement criteria, disease activity score (DAS)28, and EULAR response, as well as for safety issues.

              Results: One hundred and forty-three patients were enrolled in the open-label, long-term extension trial and 94 (66%) patients had completed 5 years as of March 2007. Thirty-two patients (22%) withdrew from the study due to adverse events and one patient (0.7%) due to unsatisfactory response. Fourteen patients withdrew because of the patient’s request or other reasons. The SAE rate was 27.5 events per 100 patient-years, with 5.7 serious infections per 100 patient-years, based on a total tocilizumab exposure of 612 patient-years. Of the 88 patients receiving corticosteroids at baseline, 78 (88.6%) were able to decrease their corticosteroid dose, and 28 (31.8%) discontinued corticosteroids. At 5 years, 79/94 (84.0%), 65/94 (69.1%) and 41/94 (43.6%) of the patients achieved ACR20, ACR50, and ACR70 improvement criteria, respectively. Remission defined as DAS28 less than 2.6 was achieved in 52/94 (55.3%) of the patients.

              Conclusion: In this 5-year extension study, tocilizumab demonstrated sustained long-term efficacy and a generally good safety profile.

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