Predictors of response and remission in a large cohort of rheumatoid arthritis patients treated with tocilizumab in clinical practice.
OBJECTIVE
The objective of this study was to identify predictors of response and remission to tocilizumab (TCZ) in RA patients seen in daily routine clinical practice.


METHODS
The efficacy of TCZ was evaluated after 12 and 24 weeks of treatment by the European League Against Rheumatism (EULAR) response criteria. Regression analysis was performed to study the association between remission or EULAR response and the following characteristics: gender, age, current smokers, prior cardiovascular disease (CVD), 28-joint disease activity score (DAS28), CRP, RF or ACPA positivity, combination therapy with DMARDs and TCZ as the first biological therapy or after failure of at least one biological therapy.


RESULTS
In total, 204 patients were included with a mean DAS28 score of 5.14. EULAR response and remission were obtained in 86.1% and 40% of patients, respectively, at week 24. In multiple regression analysis, a high baseline CRP level [odds ratio (OR) 4.454 (95% CI 1.446, 13.726)] was significantly associated with EULAR response at week 24 and, inversely, age >55 years [OR 0.285 (95% CI 0.086, 0.950)] and prior CVD [OR 0.305 (95% CI 0.113, 0.825)] were significantly associated with lower EULAR response at week 24. Older age was also associated with less remission at week 24 [OR 0.948 (95% CI 0.920, 0.978)]. No additional effectiveness was found when TCZ was used in combination with a DMARD or when patients were naive to biological agents.


CONCLUSIONS
In daily practice we identified three predictors of a better response for TCZ therapy in RA: a younger age, a high baseline CRP level and no history of CVD.
Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, CHRU Lapeyronie, 371, Avenue du Doyen Gaston Giraud, 34295 Montpellier, France. ym-pers@chu-montpellier.fr.
Yves-Marie
YM
Pers
Clémentine
C
Fortunet
Elodie
E
Constant
Joseph
J
Lambert
Marie
M
Godfrin-Valnet
Audrey
A
De Jong
Grégoire
G
Mercier
Béatrice
B
Pallot Prades
Daniel
D
Wendling
Philippe
P
Gaudin
Christian
C
Jorgensen
Hubert
H
Marotte
Jean-Francis
JF
Maillefert
D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000378:metabolism
D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; C502936:tocilizumab
C-reactive protein; cardiovascular disease; predictors of response; rheumatoid arthritis; tocilizumab; young age