Background/Purpose: Biologic therapy targeting TNF have consistently demonstrated better efficacy and effectiveness when combined with a conventional synthetic DMARD (csDMARD), most frequently methotrexate. Although pre-clinical protocols have shown the short-term efficacy of tocilizumab (TOCI) in monotherapy in very selected patients suffering from rheumatoid arthritis (RA), little is known on the long-term comparative sustainability of monotherapy (Mono) versus combo therapy (Combo). We evaluate here the comparative sustainability of tocilizumab in patients with rheumatoid arthritis initially treated with or without MTX.

Methods: Data from RHUMADATA® patients with RA prescribed TOCI either as an initial or second biologic was analyzed. Patients were followed until treatment discontinuation, loss to follow-up or April 22nd, 2018. The characteristics of selected patients were tabulated and the TOCI discontinuation rates of patients undergoing initial mono and combo therapy compared using Kaplan-Meier methods and Cox regression models adjusting for potential confounders.

Results: A total of 122 patients with RA received TOCI in first or second intention. Of those, 44(36.1%) and 78(63.9%) initially received mono and combo therapy respectively. Most patients were women (77%), mean age at diagnosis was 45.0 (SD=12.8) years, and the average age at treatment initiation was 54.5 (SD=11.8) years. HAQ and DAS28(4)-CRP at treatment initiation were respectively 1.21 (SD=0.57) and 4.64 (SD=1.01). Forty-nine and 11 percent of patients concomitantly received hydroxychloroquine (HCQ) and sulfasalazine (SSZ) respectively. Age-adjusted Carlson’s comorbidity index (ACCI) at baseline was 2.5 (SD=1.1), and 79% were RF-positive and 75% ACPA positive. Significant differences in retention rates between mono and combo TOCI therapy were observed (log-rank p-value =0.0002). Mean retention time for mono and combo-therapy were respectively 2.77(SE=0.41) and 5.13(SE=0.43) years. Use of MTX remains significant (p-value<.0001) after adjusting for gender, age and disease duration at treatment initiation, HAQ, DAS28(4)-CRP, RF and ACPA, ACCI, and concomitant use of HCQ and SSZ.

Conclusion: Combining tocilizumab with MTX significantly improves its sustainability.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/combining-tocilizumab-with-methotrexate-improves-sustainability-real-world-evidence-report-from-quebec-database-rhumadata/