PT  - JOURNAL ARTICLE
AU  - Kaneko, Yuko
AU  - Kato, Masaru
AU  - Tanaka, Yoshiya
AU  - Inoo, Masayuki
AU  - Kobayashi-Haraoka, Hitomi
AU  - Amano, Koichi
AU  - Miyata, Masayuki
AU  - Murakawa, Yohko
AU  - Yasuoka, Hidekara
AU  - Hirata, Shintaro
AU  - Tanaka, Eiichi
AU  - Miyasaka, Nobuyuki
AU  - Yamanaka, Hisashi
AU  - Yamamoto, Kazuhiko
AU  - Takeuchi, Tsutomu
ED - 
TI  - Tocilizumab discontinuation after attaining remission in patients with rheumatoid arthritis who were treated with tocilizumab alone or in combination with methotrexate: results from a prospective randomised controlled study (the second year of the SURPRISE study)
AID  - 10.1136/annrheumdis-2018-213416
DP  - 2018 Sep 01
TA  - Annals of the Rheumatic Diseases
PG  - 1268--1275
VI  - 77
IP  - 9
4099  - http://ard.bmj.com/content/77/9/1268.short
4100  - http://ard.bmj.com/content/77/9/1268.full
SO  - Ann Rheum Dis2018 Sep 01; 77
AB  - Objective To evaluate the sustained remission and low disease activity after discontinuation of tocilizumab in patients with rheumatoid arthritis who were treated with tocilizumab alone or in combination with methotrexate.Methods The SURPRISE study was a 2-year, open-label randomised controlled study. Among patients who had been randomised to additional tocilizumab (ADD-ON) or switch to tocilizumab (SWITCH) in the first year, those who achieved remission based on the disease activity score for 28 joints (DAS28-ESR<2.6) discontinued tocilizumab at week 52 and were observed for the following 52 weeks. The endpoint of the second year included tocilizumab-free remission and low disease-activity rates, functional outcome, radiological outcomes assessed with the modified total Sharp score (mTSS) and safety. The efficacy of reinstituted tocilizumab/methotrexate was also evaluated.Results A total of 105 patients who achieved remission at week 52 discontinued tocilizumab; 51 in ADD-ON continued methotrexate and 54 in SWITCH received no disease-modifying antirheumatic drugs. Sustained DAS28 low disease-activity rates were significantly higher in ADD-ON than in SWITCH (55%vs27%, p=0.005). Sustained remission rates at week 104 were 24% for ADD-ON and 14% for SWITCH (p=0.29). Radiological progression was comparable between both groups (mTSS; 0.37vs0.64, p=0.36). The restart of tocilizumab induced remission in all except two patients after 36 weeks, irrespective of concomitant methotrexate.Conclusion Sustained low disease activity after tocilizumab discontinuation could be maintained with continued methotrexate in more than half of the patients. Retreatment with tocilizumab led to remission in more than 90% of patients.Trial registration number NCT01120366; Results.