title: Drug free REmission/low disease activity after cessation of tocilizumab (Actemra) Monotherapy (DREAM) study.
abstract: OBJECTIVE
  To investigate the duration of remission and low disease activity (LDA) after cessation of tocilizumab (TCZ) treatment in rheumatoid arthritis patients who showed remission or LDA as assessed by DAS28 in response to preceding TCZ monotherapy, and to explore the factors contributing to prolonged efficacy duration.
  
  
  METHODS
  Disease activity was monitored for 56 weeks. The rate of continued efficacy was estimated by Kaplan-Meier curves.
  
  
  RESULTS
  A total of 187 patients were eligible. At baseline of this study, median disease duration was 7.8 years, preceding TCZ treatment period was 4.0 years and DAS28 was 1.5. The rate of continued LDA at 52 weeks was 13.4 % according to the Kaplan-Meier estimate. 19 patients (10 %) were completely drug-free and 17 patients (9.1 %) fulfilled DAS28 remission at 52 weeks. Multivariate Cox regression analysis identified low serum IL-6 and normalisation of MMP-3 levels at cessation of TCZ as independent predictive markers for longer duration of LDA. In patients with low serum IL-6 (<12.9 pg/mL) and normal MMP-3 levels, the rate of continued LDA reached 38.0 % at 52 weeks.
  
  
  CONCLUSIONS
  TCZ monotherapy may induce biologics-free remission or LDA without concomitant use of synthetic DMARDs. Serum levels of IL-6 and MMP-3 are useful markers for identifying patients who could discontinue TCZ without acute disease flare.
authors.affiliation: Osaka Rheumatology Clinic , Tatsuno-Sinsaibashi-Building 5th Floor, 4-4-10 Minamisenba Chuo-ku, Osaka 542-0081 , Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Nishimoto
authors.forename: Koichi
authors.initials: K
authors.lastname: Amano
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hirabayashi
authors.forename: Takahiko
authors.initials: T
authors.lastname: Horiuchi
authors.forename: Tomonori
authors.initials: T
authors.lastname: Ishii
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Iwahashi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kohsaka
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kondo
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Matsubara
authors.forename: Toshihide
authors.initials: T
authors.lastname: Mimura
authors.forename: Hisaaki
authors.initials: H
authors.lastname: Miyahara
authors.forename: Shuji
authors.initials: S
authors.lastname: Ohta
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Saeki
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Saito
authors.forename: Hajime
authors.initials: H
authors.lastname: Sano
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Takasugi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Shigeto
authors.initials: S
authors.lastname: Tohma
authors.forename: Tomomi
authors.initials: T
authors.lastname: Tsuru
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Ueki
authors.forename: Jiro
authors.initials: J
authors.lastname: Yamana
authors.forename: Jun
authors.initials: J
authors.lastname: Hashimoto
authors.forename: Takaji
authors.initials: T
authors.lastname: Matsutani
authors.forename: Miho
authors.initials: M
authors.lastname: Murakami
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takagi
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D019278:Matrix Metalloproteinase 3 / Q000097:blood; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D015850:Interleukin-6; D019278:Matrix Metalloproteinase 3; C502936:tocilizumab