Background/Purpose: Tocilizumab retreatment is effective and well tolerated in patients with rheumatoid arthritis whose disease activity flared after stopping the therapy. Therefore, reducing tocilizumab dose intensity by extending intervals is worthwhile. However,  feasibility of entended-interval(≧5 weeks) therapy with tocilizumab for rheumatoid arthritis patients in routine practice is not well known.

Methods: We studied rheumatoid arthritis (RA) patients who used tocilizumab in the Cohort of Arthritis Biologic Users at Kameda Institute (CABUKI) registry from Jan/2003 to Mar/2013. Inclusion criteria were tocilizumab users age 18 years or older and DAS28-ESR <3.2 at the start of interval extension. We studied the success rate of interval extension and baseline factors at the beginning of extended intervals that predicts successful interval extension. We defined interval extension as tocilizumab administration at intervals 5 weeks or longer. The success rate was calculated at 24 weeks. The failure to maintain the extended intervals was defined as experiencing moderate or high disease activity or requiring intensification of DMARDs or glucocorticoids during follow up periods. Analyses were conducted using Fisher’s exact test, Mann-Whitney U test, and log rank test.

Results: Among 54 patients who received tocilizumab, 22 patients underwent interval extension. Of 21 patients who were followed for 24 weeks, 13(61.9%) patients were still on extended intervals successfully, but 8(38.1%) patients had failed.  Baseline characteristics of interval extension success group and failure group were mean age 58.8 years/61.4 years (P=0.77), female 76.9%/75%(P=1.00), disease duration 6.2 years/12.5 years (P=0.09), RF positive 76.9%/100%(p=0.26), anti-CCP positive 85%/100%(p=0.52), mean DAS28-ESR 1.76/1.86(p=0.70), mean modified HAQ 0.15/0.57(p=0.20) and radiographic erosion 53.8%/87.5%(p=0.17). In the successful interval extension group, disease duration was shorter, mean modified HAQ was smaller, and the number of non-radiographic erosion was smaller than failure group. 

Conclusion: Among tocilizumab users in routine practice who underwent extended-interval administration of tocilizumab, 61.9% successfully maintained low disease activity at 24 weeks without shortening of intervals or dose intensification of non-biologic treatment. Interval extension is a feasible treatment strategy in RA patients treated with tocilizumab in routine practice.

Reference:

Norihiro Nishimoto, et al. Retreatment efficacy and safety of tocilizumab in patients with rheumatoid arthritis in recurrence (RESTORE) study. Mod Rheumatol 2013 May 3

Norihiro Nishimoto, et al. Drug free Remission/low disease activity after cessation of tocilizumab (Actemra) Monotherapy (DREAM) study. Mod Rheumatol 2013 May 17

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/success-rate-of-5-or-more-week-extended-interval-therapy-with-tocilizumab-in-rheumatoid-arthritis-patients-in-routine-practice/