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Comparable clinical response seen in patients with RA treated with Actemra alone or in DMARD combinations
The response rate was comparable between patients with rheumatoid arthritis who received Actemra as monotherapy, in combination with methotrexate or in combination with another disease-modifying antirheumatic drug, according to the results of a study.
Researchers studied 1,798 patients with rheumatoid arthritis (RA) enrolled in registries in the Czech Republic, Denmark, Finland, the Netherlands, Norway, Portugal, Russia, Slovenia, Sweden and Switzerland who began treatment with Actemra (tocilizumab, Genetech). Treatment courses involved tocilizumab as either monotherapy (n = 577), in combination with methotrexate (n = 1,011), with methotrexate and one additional disease-modifying anti-rheumatic drug (DMARD; n = 184) or with another conventional, non-biologic DMARD (n = 285).
The mean baseline Clinical Disease Activity Index (CDAI) scores varied by country, year of treatment initiation with tocilizumab, the number of prior attempts with biologic treatments and sex. The CDAI scores were lowered after initiation of tocilizumab therapy whether received as monotherapy or combined with another DMARD. A similar response was seen when patients were evaluated by the Disease Activity Score in 28 Joints (DAS28).
Disease remission was observed in about 20% overall based on CDAI or DAS28 evaluations, according to the researchers. Treatment discontinuation occurred in 39% of patients, including about half of all patients who received tocilizumab monotherapy and 52% of patients who received combination therapies. Safety issues were cited by 32% of patients who withdrew from tocilizumab monotherapy and by 28% of patients who received combined therapies. Therapy was discontinued in 23 patients who entered remission, five of whom received tocilizumab monotherapy.
The median duration of treatment was estimated as 2.3 years for patients who received tocilizumab monotherapy and 3.7 years for patients who received combination therapy. Responses to the Health Assessment Questionnaire and seropositivity were the only covariates that affected the HR for discontinuation. – by Shirley Pulawski
Disclosure: Gabay reports the receipt of fees for speaking and/or consulting from AbbVie, Bristol-Myers Squibb, Roche, Pfizer, Celgene, MSD, Janssen Cilag, Amgen and UCB, and research funding from Roche, AbbVie, MSD and Pfizer. Please see the full study for a list of all other authors’ relevant financial disclosures.