title: Importance of methotrexate therapy concomitant with tocilizumab treatment in achieving better clinical outcomes for rheumatoid arthritis patients with high disease activity: an observational cohort study.
abstract: OBJECTIVE
  The purpose of this study was to identify the effects of concomitant use of MTX and baseline characteristics for remission in the treatment of RA with tocilizumab (TCZ) in daily clinical practice.
  
  
  METHODS
  A total of 240 RA patients who received TCZ were selected from the multicentre Tsurumai Biologics Communication Registry. Predictive baseline factors for remission [28-item DAS (DAS28) < 2.6] at 52 weeks were determined by logistic regression analysis. To confirm whether the associations varied by the level of baseline disease activity, we also assessed the model including the interaction term (each baseline variable × DAS28).
  
  
  RESULTS
  In total, 49.3% of the study participants used MTX with TCZ. Even after controlling for the baseline DAS28, shorter disease duration (≤3 year) [odds ratio (OR) 3.58 (95% CI 1.81, 7.07)], less structural damage [Steinbroker stage ≤II, OR 2.33 (95% CI 1.32, 4.12)] and concomitant prednisolone use [OR 0.38 (95% CI 0.21, 0.68)] showed significant predictive values for remission. Concomitant MTX use failed to show a significant association with remission, whereas a significant interaction was observed among concomitant MTX use × DAS28 (P = 0.006). In patients with high baseline disease activity (DAS28 > 5.1), concomitant MTX use was associated with increased odds for remission [adjusted OR for all baseline variables 2.54 (95% CI 1.11, 5.83)], while no association was indicated between them in patients with low to moderate baseline disease activity (DAS28 ≤ 5.1).
  
  
  CONCLUSIONS
  Concomitant MTX use is an important component of TCZ treatment for RA patients with high disease activity.
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan. toshik@med.nagoya-u.ac.jp.
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Kojima
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yabe
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kaneko
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Nobunori
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Funahashi
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Daizo
authors.initials: D
authors.lastname: Kato
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hanabayashi
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Asai
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Hirabara
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Asai
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hirano
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Miyake
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Masayo
authors.initials: M
authors.lastname: Kojima
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan. Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001799:Blood Sedimentation; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab; D008727:Methotrexate
keywords: biologics; methotrexate; rheumatoid arthritis; tocilizumab