Background/Purpose : Tocilizumab, as an intra-venous agent, has been approved for rheumatoid arthritis (RA) in Canada in April 30^th, 2010. It was the sixth approved agent after adalimumab, etanercept, abatacept, infliximab and rituximab. It has been demonstrated effective in the treatment of RA either in monotherapy or combo therapy after non-biologic or biologic DMARDS [1-3]. The goal of this analysis is to describe its effectiveness in patients with RA failing a first anti-TNF DMARDs and to compare its retention rate versus adalimumab, etanercept and infliximab in the same   clinical situation.

Methods : All patients with RA having failed a first anti-TNF agents and subsequently exposed to tocilizumab after the 1^stof January 2005 were extracted from the Rhumadata® database. 4 cohorts were created according to the time tocilizumab or the subsequent anti-TNF agents was introduced:  One cohort of patients starting tocilizumab and 3 other cohorts starting either adalimumab, Etanercept or infliximab.  Demographics and baseline characteristics including age, gender, disease duration, Rheumatoid factor and anti-CCP antibodies, CRP and ESR, previous failed treatment number, DAS 28 ESR and CDAI, HAQ-DI were included for each cohorts.

Results : The data from 259 patients prescribed either tocilizumab (53=20%), adalimumab (97=37%), etanercept (82=33%) or infliximab (27=10%) as a second biologic agent were extracted from the Rhumadata® registry and clinical database. Mosts subjects were female (75%) and the average age of cohort subjects was 58.2 (StD=14.3). Mean CRP and ESR were respectively 17.0 (StD=29.5) mg per L and 26.6 (StD=24.1) mm per hour. No clinically significant differences at baseline were observed between groups.  The four year retention rates of tocilizumab, adalimumab, etanercept and infliximab as second line biologic agents were 44.3%, 27.2%, 37.1% and 34.0% respectively. Kaplan-Meier survival analysis revealed significant differences in the drug retention rates (logrank p=0.0249).

Conclusion : In RA patient having failed their first anti-TNF agent, tocilizumab, an Il-6 inhibitor,  could be a more valuable alternative than cycling to a second anti-TNF agent.

References :

1.           Bykerk, V.P., et al., Tocilizumab in patients with active rheumatoid arthritis and inadequate responses to DMARDs and/or TNF inhibitors: a large, open-label study close to clinical practice. Ann Rheum Dis, 2012. 71(12): p. 1950-4.

2.           Emery, P., et al., IL-6 receptor inhibition with tocilizumab improves treatment outcomes in patients with rheumatoid arthritis refractory to anti-tumour necrosis factor biologicals: results from a 24-week multicentre randomised placebo-controlled trial. Ann Rheum Dis, 2008. 67(11): p. 1516-23.

3.           Emery, P., Optimizing outcomes in patients with rheumatoid arthritis and an inadequate response to anti-TNF treatment. Rheumatology (Oxford), 2012. 51 Suppl 5: p. v22-30.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tocilizumab-use-in-patients-with-rheumatoid-arthritis-having-failed-one-previous-anti-tnf-agent-comparison-with-adalimumab-etanercept-and-infliximab/