title: Drug adherence, response and predictors thereof for tocilizumab in patients with rheumatoid arthritis: results from the Swedish biologics register.
abstract: OBJECTIVE
  To evaluate drug adherence, clinical response and predictors thereof for tocilizumab in patients with RA in routine care based on prospectively collected data from the Swedish biologics register, Anti-Rheumatic Therapies in Sweden.
  
  
  METHODS
  RA patients who had started with tocilizumab from September 2008 until March 2012 were identified. Cox regression and logistic regression models were used.
  
  
  RESULTS
  A total of 530 RA patients were included, of whom 80.6% were female, 64.7% were on concomitant DMARDs, of which 300 were on MTX and 12% were biologic naive. The overall 6 month, 1 and 2 year estimated drug continuations were 79%, 64% and 50%, respectively. In the multivariate analyses, a low initial level of CRP [hazard ratio (HR) 0.76/1 S.D. (95% CI 0.63, 0.91)], high HAQ score [HR 1.23/1 S.D. (95% CI 1.06, 1.44)] and prior exposure to different biologics [HR 1.43 (95% CI 1.12, 1.83)] were predictors for drug termination, whereas concomitant DMARD therapy was not. European League Against Rheumatism (EULAR) good, moderate, and no response were achieved by 184 (46.7%), 133 (33.8%) and 77 (19.5%) patients, respectively. Predictors for EULAR good response vs no response (at 2.5-8 months) were low HAQ [odds ratio (OR) 0.56/1 S.D. (95% CI 0.40, 0.78)], high 28-joint DAS [OR 2.0/1 S.D. (95% CI 1.44, 2.78)] and not being on prednisolone [OR 0.47 (95% CI 0.25, 0.88)] at baseline.
  
  
  CONCLUSIONS
  In this RA cohort treated with tocilizumab, the estimated 1 year drug continuation was 64% and 80% of the patients achieved a EULAR response. Drug discontinuation was not predicted by no concomitant DMARD, but by low CRP, high HAQ and prior exposure to biologics.
authors.affiliation: Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg and Department of Rheumatology, Lund University Hospital, Lund, Sweden helena.forsblad@vgregion.se.
authors.forename: Helena
authors.initials: H
authors.lastname: Forsblad-d'Elia
authors.affiliation: Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg and Department of Rheumatology, Lund University Hospital, Lund, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Bengtsson
authors.affiliation: Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg and Department of Rheumatology, Lund University Hospital, Lund, Sweden.
authors.forename: Lars Erik
authors.initials: LE
authors.lastname: Kristensen
authors.affiliation: Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg and Department of Rheumatology, Lund University Hospital, Lund, Sweden.
authors.forename: Lennart T H
authors.initials: LT
authors.lastname: Jacobsson
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology*; D001688:Biological Products / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001688:Biological Products; D002097:C-Reactive Protein; C502936:tocilizumab
keywords: clinical response; drug survival; outcome; predictor; register; tocilizumab