Comparative Effectiveness of Tocilizumab and TNF Inhibitors in Rheumatoid Arthritis Patients: Data from the Rheumatic Diseases Portuguese Register, Reuma.pt.

Vasco C Romão,Miguel Bernardes,Patrícia Nero,José António Costa,José António Melo Gomes,Cátia Duarte,Jaime Cunha Branco,José António Pereira Da Silva,Joaquim Polido-Pereira,Helena Canhão,José Alberto Pereira Da Silva,Lúcia Costa,José Canas Da Silva,Filipe Barcelos,Maria José Santos,Cláudia Miguel,João Eurico Fonseca,Fernando M Pimentel-Santos

doi:10.1155/2015/279890

Abstract

Objectives. To compare the effectiveness of TNF inhibitors (TNFi) and tocilizumab in rheumatoid arthritis (RA) treatment, according to different response criteria. Methods. We included RA patients registered in the Rheumatic Diseases Portuguese Register treated with TNFi or tocilizumab for at least 6 months, between January 2008 and July 2013. We assessed remission/low disease activity (LDA) at 6 months according to DAS28, CDAI, and SDAI, as well as Boolean ACR/EULAR remission and EULAR response rate, adjusting for measured confounders. Results. Tocilizumab-treated patients (n = 95) presented higher baseline disease activity and were less frequently naïve to biologics compared to TNFi users (n = 429). Multivariate logistic regression analysis including the propensity score for receiving tocilizumab showed that patients treated with tocilizumab were more likely to achieve remission or LDA according to DAS28 (OR = 11.0/6.2, 95% CI 5.6–21.6/3.2–12.0), CDAI (OR = 2.8/2.6, 95% CI 1.2–6.5/1.3–5.5), or SDAI (OR = 3.6/2.5, 95% CI 1.5–8.7/1.1–5.5), as well as a good EULAR response (OR = 6.4, 95% CI 3.4–12.0). However, both groups did not differ in Boolean remission (OR = 1.9, 95% CI 0.8–4.8) or good/moderate EULAR response (OR = 1.8, 95% CI 0.8–4.5). Conclusions. Compared with TNFi, tocilizumab was associated with greater likelihood of achieving DAS28, CDAI, and SDAI remission/LDA and EULAR good response. Boolean remission and EULAR good/moderate response did not differ significantly between groups.

Highlights

Tumour necrosis factor inhibitors (TNFi) were the first biological agents introduced in the treatment of rheumatoid arthritis (RA)
Comparing patients by biologic class revealed higher mean erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) and increased proportions of patients with high disease activity according to all indexes in the tocilizumab group
We found that patients treated with tocilizumab were more likely to achieve disease activity score-28 joints (DAS28), CDAI, and SDAI remission/low disease activity (LDA), as well as good European League Against Rheumatism (EULAR) response at 6 months, when adjusting for confounding factors

Summary

Introduction

Tumour necrosis factor inhibitors (TNFi) were the first biological agents introduced in the treatment of rheumatoid arthritis (RA) They have been widely used for over 15 years and extensive evidence of their efficacy and effectiveness has accumulated, arising from numerous randomised clinical trials (RCTs) and large observational studies [1,2,3,4,5,6]. Tocilizumab, a monoclonal antibody targeting the interleukin-6 receptor, has become available one decade later and has progressively gained its place into RA treatment algorithms [7] It has been included in the last 2013 European League Against Rheumatism (EULAR) recommendations as one of the potential first line biologic drugs, alongside TNFi [7], after methotrexate (MTX) and/or other synthetic diseases modifying antirheumatic drugs (DMARDs) failure, a guidance followed by several national rheumatology societies [8]. While RCTs directly assessing both classes of drugs in combination with synthetic DMARDs are missing, indirect comparisons through systematic reviews of RCTs have reported similar American College of Rheumatology (ACR) 50 responses [11, 12, 16,17,18,19] between tocilizumab and TNFi, with only one of these studies suggesting a higher ACR70 response rate with tocilizumab [16]

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