Comparative effectiveness of tocilizumab versus TNF inhibitors as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis after the use of at least one biologic disease-modifying antirheumatic drug: analyses from the pan-European TOCERRA register collaboration
Language English Country United States Media print-electronic
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
PubMed
29730637
DOI
10.1136/annrheumdis-2017-212845
PII: S0003-4967(24)02414-2
Knihovny.cz E-resources
- Keywords
- DMARDS (biologic), anti-tnf, methotrexate, rheumatoid arthritis,
- MeSH
- Antirheumatic Agents therapeutic use MeSH
- Adult MeSH
- Antibodies, Monoclonal, Humanized therapeutic use MeSH
- Kaplan-Meier Estimate MeSH
- Drug Therapy, Combination MeSH
- Middle Aged MeSH
- Humans MeSH
- Proportional Hazards Models MeSH
- Registries MeSH
- Arthritis, Rheumatoid drug therapy MeSH
- Aged MeSH
- Severity of Illness Index MeSH
- Tumor Necrosis Factor-alpha antagonists & inhibitors MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Antirheumatic Agents MeSH
- Antibodies, Monoclonal, Humanized MeSH
- Tumor Necrosis Factor-alpha MeSH
- tocilizumab MeSH Browser
OBJECTIVE: To compare the effectiveness of tocilizumab (TCZ) and tumour necrosis factor (TNF) inhibitors (TNFi) as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA) after the use of at least one biologic DMARD (bDMARD). METHODS: We included patients with RA having used at least one bDMARD from 10 European registries. We compared drug retention using Kaplan-Meier and Cox models and Clinical Disease Activity Index (CDAI) change over time with mixed-effects models for longitudinal data. The proportions of CDAI remission and low disease activity (LDA) at 1 year were compared using LUNDEX correction. RESULTS: 771 patients on TCZ as monotherapy (TCZ mono), 1773 in combination therapy (TCZ combo), 1404 on TNFi as monotherapy (TNFi mono) and 4660 in combination therapy (TNFi combo) were retrieved. Crude median retention was higher for TCZ mono (2.31 years, 95% CI 2.07 to 2.61) and TCZ combo (1.98 years, 95% CI 1.83 to 2.11) than TNFi combo (1.37 years, 95% CI 1.30 to 1.45) and TNFi mono (1.31 years, 95% CI 1.18 to 1.47). In a country and year of treatment initiation-stratified, covariate-adjusted analysis, hazards of discontinuation were significantly lower among patients on TCZ mono or combo compared with patients on TNFi mono or combo, and TNFi combo compared with TNFi mono, but similar between TCZ mono and combo. Average adjusted CDAI change was similar between groups. CDAI remission and LDA rates were comparable between groups. CONCLUSION: With significantly longer drug retention and similar efficacy to TNFi combo, TCZ mono or combo are reasonable therapeutic options in patients with inadequate response to at least one bDMARD.
ARBITER Institute of Rheumatology Moscow Russian Federation
BioRx si University Medical Centre Ljubljana Ljubljana Slovenia
Center of Rheumatic Diseases University of Medicine and Pharmacy Bucharest Romania
Charles University Prague Czech Republic
Department of Rheumatology Diakonhjemmet Hospital Oslo Norway
F Hoffmann La Roche AG Basel Switzerland
Genentech South San Francisco California USA
Geneva University Hospitals Geneva Switzerland
GISEA University Hospital of Bari Bari Italy
Rheumatology Department Hospital Clinic Barcelona Barcelona Spain
Rheumatology Department Hospital Garcia de Orta on behalf of Reuma pt Almada Portugal
ROB FIN Helsinki University Hospital and Helsinki University Helsinki Finland
References provided by Crossref.org
EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis
