VBCR - June 2015, Volume 4, No 3 - In the Literature

Initiation of therapy with tocilizu­mab (Actemra; Genentech) enabled rapid and long-lasting reductions in corticosteroid (CS) use in patients with severe and active rheumatoid arthritis (RA) who had been on oral CS therapy for at least 3 months at baseline. CS sparing did not correlate with reduction in disease activity; therefore, tocilizumab may have positive effects (ie, CS sparing) in patients not having clinical responses.

“The study showed that TCZ [tocilizumab] led to significant CS sparing during the first months of RA treatment, and that this sparing effect was observed even in non-responders, in whom the treatment could thus have major benefits despite the absence of response. Other studies are now necessary to confirm these findings and to evaluate the hypotheses put forward,” the authors wrote. They noted, “In RA patients treated with high doses of CS, clinicians’ main objective might be to reduce doses.”

The multicenter, observational, retrospective study evaluated 220 patients with RA, with a mean age of 55.7 years, mean disease duration 15.9 years, and a mean disease activity score (DAS28) of 5.1, who started tocilizumab treatment at 5 centers between December 2009 and June 2011. Among these, 132 were on long-term oral CS therapy. Of these patients, 2 were excluded, leaving 130 patients in the analysis (105 women [80.8%] and 25 men; mean age of 56.7 years). Mean duration of RA was 16.3 years. RA was active in most patients (mean baseline DAS28 of 5.1). Mean CS dose was 10 mg/day (mean prednisone equivalent).

Mean duration of follow-up was 21.3 weeks. Nineteen patients stopped treatment after 4 to 12 weeks for various reasons. During the study period, a significant CS-sparing effect was observed by week 24; mean daily dose of oral CS was reduced from 10 mg at baseline to 6.5 mg at week 24 (P<.0001). Along with that, mean DAS28 during the study period decreased from 5.1 to 3.0 at week 24 (P<.0001).

Among 90 patients not receiving CS at baseline, 13 received CS during the study period. The only variable found to correlate with the decrease in CS dose was initial dose of the drug (r=0.82; P<.001). When these patients were added into a post hoc analysis, the early and long-lasting CS-sparing effect was observed.

The study’s limitations are its open observational design and lack of a comparator group. However, the patients are those seen in “real life.” Fortunet C, et al. Rheumatology (Oxford). 2015;54(4):672-677.

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