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Fatigue scores improve for some patients with RA after Actemra treatment
Certain patients with rheumatoid arthritis had improvements in fatigue scores within 15 days of treatment with Actemra, and the improvements correlated more closely with improvements in the Health Assessment Questionnaire and psychological status than with disease activity, according to the results of a French study.
Researchers analyzed the data from 610 patients with rheumatoid arthritis (RA) enrolled in a prospective, observational, multicenter study between January 2010 and May 2011. Concomitant use of oral corticosteroids was present in 69% of patients and 66% of patients received concomitant methotrexate or other disease-modifying anti-rheumatic drug (DMARD).
Laure Gossec
Patients were evaluated at baseline and follow-up visits using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), the Disease Activity Score in 28 joints (DAS28) the Patient’s Global Assessment of Disease Activity (PGA) on a VAS (0–100), Health Assessment Questionnaire Disability Index (HAQ), a VAS each for pain and sleep quality and the Hospital Anxiety and Depression Scale (HADS). At each visit, the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured.
Patients were treated with Actemra (tocilizumab, Genentech) for 4 months at which time complete patient data was available for 417 patients.
At baseline, the mean FACIT score was 24 and 73% of patients characterized fatigue levels as “unacceptable” vs. “acceptable” on a patient acceptable symptom state (PASS) question. At day 15, FACIT-Fatigue scores were reduced by 9% and by 31% at month 4. Clinically significant improvement in fatigue based on an increase of at least 4 points on the FACIT-Fatigue scale was seen in 62% of patients with RA at month 4.
A more recent diagnosis of RA, higher CRP levels and greater fatigue at baseline were associated with a greater reduction in fatigue. A higher baseline VAS for pain correlated with improvements in fatigue scores when baseline fatigue status was omitted.
At month 4, a weak but positive correlation was seen between improvement of FACIT-Fatigue and DAS28 scores, and 65% of patients who had improvements in fatigue also had a low DAS28 compared with 45% of patients without an improvement in fatigue scores. Psychological status and HAQ were more likely to be associated with improvements in fatigue compared to disease variables, according to the researchers. – by Shirley Pulawski
Disclosure: Gossec reports the receipt of fees for speaking and/or consulting from AbbVie, Janssen, MSD, Novartis, Pfizer, Roche-Chugai and UCB. Please see the full study for a list of all other authors’ relevant financial disclosures.