Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Tocilizumab (TCZ) as monotherapy (Mono) is nowadays a standard treatment in rheumatoid arthritis (RA) for patients in whom methotrexate (MTX) gives an inadequate response1.
The objective was to describe factors influencing the use of TCZ in Mono or in combination with DMARDs (Combo) in real-life practice in RA patients (pts).
Analysis: pooled data of 2 prospective, multicentre, observational studies (Spare-1 n=307, Act-solo n=577). Patients: RA pts requiring TCZ treatment according to their physician. Treatment: TCZ as prescribed in real life. Endpoint: Evaluation of factors influencing the use of TCZ in Mono or in Combo. Data collected: demographic characteristics, past medical history, RA characteristics and history including previous RA treatments, TCZ treatment strategy (in Mono or Combo). Statistical analysis: Pts fulfilling inclusion and non-inclusion criteria and with ≥1 TCZ infusion were analyzed. 1- descriptive analysis 2- Univariate and multivariate analysis to determine factors influencing the use of TCZ in Mono. 3.-A propensity score was built to balance baseline characteristics.
884 pts were analysed at inclusion. Pts’ characteristics: 57% of the pts were >55 years old, 78.4% female, mean RA duration 10.7±9.1 years, 84.3% positive for RF and/or ACPA, 77.5 % with erosive disease, CRP 19.4±26.2 mg/l, mean DAS28-ESR 5.14±1.27. Comorbidities were: diabetes 8%, high blood pressure (HBP) 28%, dyslipidemia 20%, osteoporosis 21%, others 56%. Past RA treatment included csDMARDs in 98.2% and biologics in 73.8% (median=2 [1-6]). TCZ was initiated as Mono in 39% of pts and in Combo in 61%, with MTX in 78.5% of Combo pts (mean dose 16.1±4.5mg). Steroids were used in 78.5% of pts (mean dose 11±6.8mg). In the multivariate analysis variables associated with a TCZ prescription in Mono were: number of previous bDMARD (1 bDMARD, OR=1.30 [0.88-1.93], 2 bDMARD OR=2.32 [1.55-3.45], ≥ 3 bDMARD, OR=1.21 [0.78-1.90]] p<.001), HBP OR=1.45 [1.05-2.00], p=0.025, osteoporosis OR=1.63 [1.14-2.33], p=0.007, CRP ≥10mg/l OR=1.61 [1.21-2.15], p=0.001. At 12 months, mean DAS28-ESR was 2.41±1.28 and 2.29±1.23 with 74.7% and 77% of pts in DAS28 LDA in Mono and Combo respectively. No differences were observed between Mono and Combo groups on other efficacy data. This remains true when weighting by the propensity score.
This pooled analysis suggests that TCZ in monotherapy is used more often in previously heavily treated, with higher inflammatory markers and with comorbidities such as HBP or osteoporosis.
Ref.: 1. JS. Smolen et al, Ann Rheum Dis doi:10.1136/annrheumdis-2013-204573
To cite this abstract in AMA style:Saraux A, Flipo RM, Combe B, Tebib J, Baffie C, Idier I, Cantagrel A. Factors Influencing the Prescription of Tocilizumab Alone or in Combination with Dmards in Rheumatoid Arthritis Patients in a Real Life Setting. Pooled Analysis of 2 Observational Studies [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/factors-influencing-the-prescription-of-tocilizumab-alone-or-in-combination-with-dmards-in-rheumatoid-arthritis-patients-in-a-real-life-setting-pooled-analysis-of-2-observational-studies/. Accessed October 27, 2021.
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