title: Disease activity score 28 may overestimate the remission induction of rheumatoid arthritis patients treated with tocilizumab: comparison with the remission by the clinical disease activity index.
abstract: We evaluated the efficacy of tocilizumab (TCZ) in patients with rheumatoid arthritis (RA) by the clinical disease activity index (CDAI) and disease activity score (DAS) 28-erythrocyte sedimentation rate (ESR). Thirty-two RA patients received 8 mg/kg of TCZ intravenously every 4 weeks for 48 weeks. The therapeutic response was also evaluated in 30 RA patients treated with 3 mg/kg of infliximab (IFX) for 46 weeks. We compared the therapeutic course of TCZ with IFX in order to evaluate the efficacy of TCZ therapy. A strong positive correlation between CDAI and DAS28-ESR was observed at baseline, whereas their associations dropped significantly within the first 2 months. The association recovered to the baseline by IFX, but still remained low in TCZ. Although a decrement of DAS28-ESR was prominent in TCZ as compared with IFX, that of CDAI was significant in the early phase and even in the latter in patients treated by IFX. The present study revealed that DAS28-ESR may not be sufficient to estimate RA disease activity treated by TCZ, probably due to the significant effect toward inhibition of acute phase reactants by TCZ. CDAI is suggested to be an important alternate of composite measure in these cases.
authors.affiliation: Unit of Translational Medicine, Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. shin-ya@hotmail.co.jp
authors.forename: Shin-Ya
authors.initials: SY
authors.lastname: Kawashiri
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawakami
authors.forename: Naoki
authors.initials: N
authors.lastname: Iwamoto
authors.forename: Keita
authors.initials: K
authors.lastname: Fujikawa
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Aramaki
authors.forename: Mami
authors.initials: M
authors.lastname: Tamai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamasaki
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Ueki
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Migita
authors.forename: Akinari
authors.initials: A
authors.lastname: Mizokami
authors.forename: Tomoki
authors.initials: T
authors.lastname: Origuchi
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Aoyagi
authors.forename: Katsumi
authors.initials: K
authors.lastname: Eguchi
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy*; D001799:Blood Sedimentation; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000069285:Infliximab; C502936:tocilizumab