Effectiveness of tocilizumab with and without synthetic disease-modifying antirheumatic drugs in rheumatoid arthritis: results from a European collaborative study
C Gabay, M Riek, ML Hetland, EM Hauge, K Pavelka, M Tomšič, H Canhao, K Chatzdionysiou, G Lukina, DC Nordström, E Lie, I Ancuta, MV Hernández, PLMC van Riel, R van Vollenhoven, TK Kvien. - Ann Rheum Dis. 2015 Sep 15. doi:10.1136/ annrheumdis-2015-207760
Biological DMARDs have markedly changed the management and outcome of rheumatoid arthritis. Most international guidelines recommend the use of biological DMARDs in combination with MTX or other synthetic DMARDs (sDMARDs) (where MTX is not tolerated or contraindicated), based primarily on the observation that MTX enhances the efficacy of TNF antagonists in both clinical trials and observational studies.
This study examined the effectiveness of tocilizumab (TCZ), an anti-IL-6 monoclonal antibody, with and without synthetic DMARDs in a large observational study. Patients from multiple European registries with rheumatoid arthritis treated with TCZ who had a baseline visit and information on concomitant sDMARDs were included. Prescription of TCZ as monotherapy varied according to some intrinsic patient characteristics (age and use of corticosteroids), as well as the extrinsic factors, country of the registry and year of treatment initiation. The change of disease activity assessed by CDAI and DAS28, as well as the likelihood to be in remission, was not significantly different whether TCZ was used as monotherapy or in combination with sDMARDs. However, TCZ retention was more prolonged when TCZ was prescribed in combination with sDMARDs.
The study found that 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.