Background/Purpose: Rheumatoid arthritis (RA) is an autoimmune disease systemic, with a prevalence 0.5 – 1% of the population, with predilection for the female sex. (1) Tocilizumab (TCZ) is a humanized monoclonal antibody directed against the receptor Soluble and Membrane Interleukin-6, (2) Different Studies have demonstrated the non-inferiority of subcutaneous (sc) TCZ compared to intravenous (iv) TCZ. (3,4,5) Evidence of its efficacy in patients with sustained remission of 24 weeks or plus. 6 Following the COVID 19 pandemic and with initial results promising use of IV TCZ in these patients, the authorities of Our country considered it appropriate to change the administration of this drug in patients with RA who used it to TCZ sc every 10 days, from May 2020, with the aim of rationalizing and avoiding shortages and use IV TCZ in patients with COVID 19.

Methods: Observational, prospective, and longitudinal study, between May and October 2020, consultation patients with RA at weeks 0, 12 and 24 of rheumatology service of the Hospital Docente Padre Billini. CDAI, DAS 28, ESR, hemogram, TGO, TGP, Cholesterol, Triglycerides were measured. Inclusion criteria: > 18 years, diagnosis of RA according to the ACR / EULAR 2010 classification criteria, previous treatment with Tocilizumab EV in mono or therapy combined for more than 6 months of continuous use. The data is analyzed with SPSS V23.

Results: 119 met inclusion criteria. 93.2% (111) female, 78.15% (93) concomitant scDMARD, 21.8% (26) monotherapy, 12.6% (15) glucocorticoids. Baseline DAS28: 65.54% (78) low activity, 23.5% (28) remission, 9.2% (11) moderate activity, 1.6% (2) high activity. Baseline DAS28 mean: 2.75. CDAI baseline: 52.94% (63) remission, 44.53% (53) low activity, 2.52% (3) moderate activity, mean baseline CDAI: 2. 76.4% (91) ESR elevated. Week 12: DAS28: 62.1% (74) low activity, 26.8% (32) remission, 10.9% (13) moderate activity. CDAI week 12: 55.46% (66) remission, 31% (40) low activity, 10.92% (13) moderate activity. 73.1% (87) elevated ESR. Week 24: DAS 8: 58.8% (70) low activity, 16.8% (20) remission, 14.2% (17) moderate activity and 3.3% (4) high activity. CDAI week 24: 83.19% (99) remission, 10.92% (13) low activity, 2.52% (3) moderate activity, 2.52% (3) high activity. 76.4% (91) ESR elevated. Average DAS28: 2.9 and Average CDAI: 1 at week 24. Worsening at week 24 (DAS 28) 6.7% (8) from remission to low activity, 5.04% (7) low to moderate activity and 2.52% from moderate to high activity, CDAI showed improvement from low activity to remission of 22.6% and worsening from moderate to high activity 2.5%. ΔDAS 28: 0.15, CDAI: -1. Adverse events 1.6% (2) site reaction of injection, 2.52% (3) TGO and elevated TGP, were not reported hematologic events, dyslipidemia, or serious infections.

Conclusion: In our study, the change in the administration route and time of application of Tocilizumab did not demonstrate exacerbation, this option assessed circumstantially could be a possibility of dose optimization in patients with low clinical activity or remission for at least 6 months and good safety profile, which would reduce costs in the long term. We recommend a study with a longer period.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effectiveness-and-safety-of-tocilizumab-sc-every-10-days-in-patients-with-rheumatoid-arthritis-who-previously-used-tocilizumab-ev-during-the-covid-19-pandemic-at-the-hospital-docente-padre-billini-do/