title: Efficacy and safety of tocilizumab in refractory rheumatoid arthritis: a real life cohort from a single centre.
abstract: OBJECTIVE
  Tocilizumab (TCZ) is an effective treatment in patients with rheumatoid arthritis (RA) refractory to anti-tumour necrosis factor-α. However, only few studies in real life have evaluated the efficacy of TCZ in long-standing rheumatoid arthritis (LSRA). Our aim was to evaluate the efficacy and safety of tocilizumab in refractory LSRA.
  
  
  METHODS
  Twenty-seven consecutive patients with refractory LSRA treated with at least one biologic agent were enrolled in a 19-month study in a single centre. Demographic [age, gender, disease duration, body mass index (BMI), previous therapies], clinical [total swollen and tender joints count (SJC-TJC) on 28, 44 and 68 joints, DAS28, Health Assessment Questionnaire (HAQ), infections, cardiovascular, renal, pulmonary and metabolic comorbidities], and serological [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibodies] data were collected. Patients were evaluated at baseline, and after three and six months.
  
  
  RESULTS
  Mean disease duration was 16.75±9.94 years. Seventeen out of 27 (62.9%) were RF positive and 13/27 (48.1%) were CCP positive. All of them experienced at least one previous biological agent (mean value 1.9±1.15; range 1-6). We observed a progressive reduction in all clinical and clinimetric features evaluated as well as a progressive reduction in steroids use. The EULAR response also improved. By analysing the RF positive subgroup we found that there is a better clinical response both at the 3rd and 6th month.
  
  
  CONCLUSIONS
  TCZ is an effective and safe treatment in refractory LSRA.
authors: Rheumatology Unit, Arcispedale Santa Maria Nuova, I.R.C.C.S, Reggio Emilia, Italy. olga.addimanda@asmn.re.it.
authors: Olga
authors: O
authors: Addimanda
authors: Niccolò
authors: N
authors: Possemato
authors: Pierluigi
authors: P
authors: Macchioni
authors: Carlo
authors: C
authors: Salvarani
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013256:Steroids / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001688:Biological Products; D015415:Biomarkers; D013256:Steroids; C502936:tocilizumab