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Effectiveness of tocilizumab with and without synthetic disease-modifying antirheumatic drugs in rheumatoid arthritis: results from a European collaborative study
  1. Cem Gabay1,
  2. Myriam Riek2,
  3. Merete Lund Hetland3,4,
  4. Ellen-Margrethe Hauge5,
  5. Karel Pavelka6,
  6. Matija Tomšič7,
  7. Helena Canhao8,
  8. Katerina Chatzidionysiou9,
  9. Galina Lukina10,
  10. Dan C Nordström11,
  11. Elisabeth Lie12,
  12. Ioan Ancuta13,
  13. M Victoria Hernández14,
  14. Piet L M C van Riel15,
  15. Ronald van Vollenhoven9,
  16. Tore K Kvien12
  1. 1Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
  2. 2SCQM Foundation, Zurich, Switzerland
  3. 3DANBIO, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
  4. 4Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
  5. 5Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
  6. 6Institute of Rheumatology and Clinic of Rheumatology, Charles University Prague, Prague, Czech Republic
  7. 7University Medical Center, Ljubljana, Slovenia
  8. 8Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal, on behalf of the Rheumatic Diseases Portuguese Register (
  9. 9The Karolinska Institute, Stockholm, Sweden
  10. 10Institute of Rheumatology, Moscow, Russia
  11. 11Department of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
  12. 12Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  13. 13Cantacuzino Hosp, Bucharest, Romania
  14. 14Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
  15. 15Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
  1. Correspondence to Professor Cem Gabay, Division of Rheumatology, Department of Medical Specialties, University Hospitals of Geneva, Switzerland, 26 Avenue de Beau-Séjour, 1211 Geneva 14, Switzerland; cem.gabay{at}


Objectives To examine the effectiveness of tocilizumab (TCZ) with and without synthetic disease-modifying antirheumatic drugs (sDMARDs) in a large observational study.

Methods Patients with rheumatoid arthritis treated with TCZ who had a baseline visit and information on concomitant sDMARDs were included. According to baseline data, patients were considered as taking TCZ as monotherapy or combination with sDMARDs. Main study outcomes were the change of Clinical Disease Activity Index (CDAI) and TCZ retention. The prescription of TCZ as monotherapy was analysed using logistic regression. CDAI change was analysed with a mixed-effects model for longitudinal data. TCZ retention was analysed with a stratified extended Cox model.

Results Multiple-adjusted analysis suggests that prescription of TCZ as monotherapy varied according to age, corticosteroid use, country of the registry and year of treatment initiation. The change of disease activity assessed by CDAI as well as the likelihood to be in remission were not significantly different whether TCZ was used as monotherapy or in combination with sDMARDs in a covariate-adjusted analysis. Estimates for unadjusted median TCZ retention were 2.3 years (95% CI 1.8 to 2.7) for monotherapy and 3.7 years (lower 95% CI limit 3.1, upper limit not estimable) for combination therapies. In a covariate-adjusted analysis, TCZ retention was also reduced when used as monotherapy, with an increasing difference between mono and combination therapy over time after 1.5 years (p=0.002).

Conclusions TCZ with or without concomitant sDMARDs resulted in comparable clinical response as assessed by CDAI change, but TCZ retention was shorter under monotherapy of TCZ.

  • Rheumatoid Arthritis
  • Treatment
  • DMARDs (biologic)
  • DMARDs (synthetic)

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