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Tocilizumab/methotrexate efficacy superior to other combined therapies for RA patients
Patients with rheumatoid arthritis experienced improved response when switching from either etanercept or infliximab with methotrexate to tocilizumab plus methotrexate, but not when substituting tocilizumab for etanercept, according to study results.
Researchers conducted a retrospective study of 33 patients with rheumatoid arthritis who were unresponsive to etanercept or infliximab. Patients switching from etanercept to tocilizumab (n=17; mean age, 65.6 years; 71% women) were compared with those switching from infliximab to tocilizumab (n=16; mean age, 53.9 years; 88% women). Patients began 8 mg/kg tocilizumab infusions every 4 weeks for 52 weeks, while maintaining treatment with disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate (MTX).
Fifteen patients from each cohort (88.2% former etanercept; 94.1% former infliximab) completed 52 weeks of tocilizumab treatment. At 24 weeks, significant reductions from baseline occurred in Disease Activity Score 28-C Reactive Protein (DAS28-CRP), Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) for both cohorts, with no significant differences between groups. At 52 weeks, patients who switched from infliximab had increases in DAS28-CRP, SDAI and CDAI values compared with patients who switched from etanercept (P=.0158, P=.0335 and P=.0265, respectively). MTX was used by all patients who switched from infliximab.
Researchers also compared patients who switched from etanercept monotherapy (n=10) with patients who switched from etanercept plus MTX (n=7) and infliximab plus MTX (n=16). At 24 weeks, a significant improvement was displayed from baseline in DAS28-CRP, SDAI and CDAI for all groups, with no significant differences between cohorts. In cohorts that switched from etanercept plus MTX or infliximab plus MTX, disease activity was maintained at 52 weeks; however, efficacy decreased in the cohort switching from etanercept monotherapy to tocilizumab monotherapy.
“Tocilizumab plus MTX demonstrated acceptable safety and tolerability and clinically meaningful efficacy over 52 weeks in patients with an inadequate response to infliximab plus MTX or etanercept plus MTX,” the researchers concluded. “The efficacy of tocilizumab monotherapy was decreased due to secondary loss of efficacy in the treatment of patients switching from etanercept monotherapy.”