Tocilizumab effective for ‘real world’ refractory RA patients
MedWire News: Results from the REACTION study confirm the efficacy of tocilizumab for rheumatoid arthritis (RA) in a "real world" setting.
The findings, published in the journal Rheumatology, show that the biological drug, which targets the interleukin (IL)-6 receptor, achieved significant levels of clinical and functional remission and halted radiographic progression in patients with refractory RA.
The Actemra Investigation for Optimal Needs of RA Patients (REACTION) 52-week study included 323 Japanese patients, aged an average of 59 years, who had an average RA duration of 12.4 years. The patients had a mean 28-joint Disease Activity Score (DAS-28) of 5.6, indicating active disease, despite receiving at least 3 months of treatment with nonbiological disease-modifying antirheumatic drugs (DMARDs). The majority (68.2%) of patients had also previously received an anti-tumor necrosis factor biological agent.
The patients received infusions of tocilizumab 8 mg/kg at 4-week intervals and were examined every 4 weeks for 52 weeks for swollen and tender joints, disease activity, disability, C-reactive protein, and erythrocyte sedimentation rate. X-rays were examined at baseline and again after 52 weeks.
At week 52, 43.7% of the patients were in clinical remission, defined as a DAS-28 score of below 2.6, and 26.4% had achieved functional remission, defined as a Health Assessment Questionnaire disability index (HAQ-DI) score of 0.5 or below, indicating no difficulty with most activities of daily living.
In addition, 62.8% of patients achieved radiographic nonprogression, report Tsutomu Takeuchi (Keio University, Tokyo, Japan) and co-authors.
The trial was completed by 71.1% of patients with similar retention rates among patients who had and had not received anti-TNF treatment previously. In all, 15.5% of patients discontinued tocilizumab therapy due to adverse reactions, with pneumonia the most common adverse event.
Multivariate analysis indicated that clinical remission after 52 weeks of tocilizumab therapy was significantly predicted by DAS-28 and HAQ-DI scores, and concomitant treatment with methotrexate and glucocorticoids. Specifically, HAQ-DI significantly predicted clinical, radiographic and functional remission with the lower the baseline value, the better the likelihood of remission.
"Considering factors such as the severe baseline HAQ in the present study, our findings suggest that administration of tocilizumab before worsening of HAQ, in the very early stage, might lead to attaining rates of high clinical, structural and functional remission," Takeuchi et al conclude.
"We should master use of tocilizumab towards achievement of a higher treatment goal in RA patients."
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By Lynda Williams