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Tocilizumab may help patients with RA with poor response to methotrexate
The administration of tocilizumab in combination with methotrexate may be more effective than tocilizumab monotherapy for patients who did not adequately respond to methotrexate, according to recently published research.
A group of 223 patients with moderate to severe rheumatoid arthritis (RA) were randomized to either a group of patients switched from methotrexate to tocilizumab (Actemra, Genentech) or who received methotrexate plus tocilizumab for 2 years. At baseline, included patients received 6-mg or higher doses of methotrexate for at least 8 weeks, and were excluded in the presence of leflunomide therapy within 12 weeks of enrollment, tacrolimus within 4 weeks of enrollment, prednisolone or equivalent of 10 mg per day or higher or use of other disease-modifying antirheumatic drugs.
At weeks 4 and 24, the remission rates were significantly higher in the patients who added tocilizumab to methotrexate compared to those who switched from methotrexate to tocilizumab monotherapy, although remission rates were comparable at week 52. Disease activity was not significantly different in either group, but a trend toward greater improvement in the group that added tocilizumab to methotrexate was observed. The remission rate was also significantly higher at week 8 in a subset analysis of 55% of patients with available data.
No significant differences in structural changes, based on the modified Total Sharp Score were apparent between the 63 patients who achieved remission in either the group that switched to or the group that added tocilizumab. A reduction in radiographic progression in patients who added tocilizumab to methotrexate was attributed to a greater reduction of inflammation in the first 24 weeks of the study compared to monotherapy patients. – by Shirley Pulawski
Disclosure: Kaneko reports the receipt of lecture fees from AbbVie GK, Eisai Co.,
Chugai Pharmaceutical Co., Eli Lilly Japan K.K., Mitsubishi-Tanabe, Bristol-Myers K.
K., Astellas Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Pfizer, Janssen,
Santen, Kyowa Hakko Kirin and UCB Japan. Please see the full study for a list of all other authors’ relevant financial disclosures.