title: Tocilizumab induces corticosteroid sparing in rheumatoid arthritis patients in clinical practice.
abstract: OBJECTIVE
  . The aim of this study was to evaluate the impact of introducing tocilizumab (TCZ) as co-therapy with CS in patients with RA.
  
  
  METHODS
  This study was an open, observational, retrospective multicentre study. RA patients treated with oral CS for >3 months who started treatment with TCZ between December 2009 and June 2011 in five centres were included. Variables included demographic data, disease history, co-treatments, disease activity and dose of CS at inclusion and at weeks 4, 8, 12 and 24. The evolution of disease activity and of the dose of CS (analysis of variance with repeated measures) were analysed, searching for factors correlated with changes in the dose of CS.
  
  
  RESULTS
  Inclusion of 130 patients [women 80.8%, mean age 56.7 years (s.d. 14.0), RA duration 16.3 years (s.d. 10.4), mean baseline 28-joint DAS (DAS28) 5.1 (s.d. 1.4), mean baseline dose of CS 10.0 mg/day (s.d. 8.2) prednisone equivalent. Decreases in the mean daily dose of CS and in the DAS28 were observed during follow-up [respectively 6.5 mg (s.d. 4.8) at week 24 (P < 0.0001) and 3.0 mg (s.d. 1.4) at week 24 (P < 0.0001)]. The only variable that correlated with the decrease in the dose of CS was the initial dose of the drug (r = 0.82, P < 0.001).
  
  
  CONCLUSIONS
  The introduction of TCZ led to rapid and long-lasting CS sparing that did not correlate with the reduction in disease activity. It is possible that in patients treated with high-dose CS, the main objective of the clinician is to reduce dosage of CS rather than RA activity.
authors.affiliation: Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France. Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France. clementinefortunet@gmail.com.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Fortunet
authors.affiliation: Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France.
authors.forename: Yves-Marie
authors.initials: YM
authors.lastname: Pers
authors.affiliation: Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lambert
authors.affiliation: Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Godfrin-Valnet
authors.affiliation: Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Constant
authors.affiliation: Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Devilliers
authors.affiliation: Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaudin
authors.affiliation: Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Jorgensen
authors.affiliation: Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France.
authors.forename: Béatrice Pallot
authors.initials: BP
authors.lastname: Prades
authors.affiliation: Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.affiliation: Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France. Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France.
authors.forename: Jean Francis
authors.initials: JF
authors.lastname: Maillefert
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D005938:Glucocorticoids; C502936:tocilizumab; D011241:Prednisone
keywords: biologics; corticosteroids; rheumatoid arthritis; tocilizumab; treatment