Background/Purpose:  The advent of biological therapies in rheumatoid arthritis has significantly reduced the activity of rheumatoid arthritis, leading to obtaining a remission in a significant proportion of patients. However, few data are available to determine the feasibility of decrease of a biological DMARD and define the strategy once remission is achieved.

Methods:  This retrospective multicenter study have included patients with rheumatoid arthritis treated with tocilizumab (8mg/kg every 4 weeks) for at least 6 months and who have been a decrease dose for reasons of efficacity. Data were collected in major hospitals in the region Hauts-de-France, 3 months, 6 months and 12 months after reducing tocilizumab (study conducted between 1 January 2010 and 31 December 2015).

Results:  337 patients were included in the analysis. 48 patients had a decrease because of efficacity. All of them were in DAS remission (DAS28 < 2.6) with a mean DAS28 CRP 1.55. 42 patients had a dose reduction to 4mg/kg, when 6 patients had a spacing of the infusions every 6 weeks. At 12 months, the median ΔDAS was 0.49 (p = 0.0002). DAS28 CRP usual dose group was higher than in the Efficacy group (2.99 vs 2.12, p <0.0001). 30 patients (70%) were able to maintain remission (61%) or low dose activity (9%). 4 patients have a DAS28 CRP higher than 3.2 at 12 months. 7 patients (16%) resumed tocilizumab 8mg/kg every 4 weeks before the end of the follow. In case of resumption of tocilizumab in usual dose, there was no significant difference between the initial DAS28 and DAS28 at 3 months (p = 0.1563 and 0.2197) and 6 months of recovery (p = 0.8125 and 0.8984). There was no significant increase of methotrexate or corticosteroids (p <0.0001). The initial weight, a long period of remission before decrease, a low DAS28 CRP appeared predictive of favorable response at 12 months (p = 0.016, 0.012 and 0.0032).

Conclusion:  Our study demonstrates the feasibility, safety and efficacy of tocilizumab decrease dose (from 8 to 4mg/kg), to maintain remission or low activity in a majority of patients without concomitant increase in corticosteroids or conventional DMARD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/decrease-of-tocilizumab-in-rheumatoid-arthritis-in-remission-a-multicenter-study/