title: Comparative Effectiveness of Tocilizumab and TNF Inhibitors in Rheumatoid Arthritis Patients: Data from the Rheumatic Diseases Portuguese Register, Reuma.pt.
abstract: OBJECTIVE
  To compare the effectiveness of TNF inhibitors (TNFi) and tocilizumab in rheumatoid arthritis (RA) treatment, according to different response criteria.
  
  
  METHODS
  We included RA patients registered in the Rheumatic Diseases Portuguese Register treated with TNFi or tocilizumab for at least 6 months, between January 2008 and July 2013. We assessed remission/low disease activity (LDA) at 6 months according to DAS28, CDAI, and SDAI, as well as Boolean ACR/EULAR remission and EULAR response rate, adjusting for measured confounders.
  
  
  RESULTS
  Tocilizumab-treated patients (n = 95) presented higher baseline disease activity and were less frequently naïve to biologics compared to TNFi users (n = 429). Multivariate logistic regression analysis including the propensity score for receiving tocilizumab showed that patients treated with tocilizumab were more likely to achieve remission or LDA according to DAS28 (OR = 11.0/6.2, 95% CI 5.6-21.6/3.2-12.0), CDAI (OR = 2.8/2.6, 95% CI 1.2-6.5/1.3-5.5), or SDAI (OR = 3.6/2.5, 95% CI 1.5-8.7/1.1-5.5), as well as a good EULAR response (OR = 6.4, 95% CI 3.4-12.0). However, both groups did not differ in Boolean remission (OR = 1.9, 95% CI 0.8-4.8) or good/moderate EULAR response (OR = 1.8, 95% CI 0.8-4.5).
  
  
  CONCLUSIONS
  Compared with TNFi, tocilizumab was associated with greater likelihood of achieving DAS28, CDAI, and SDAI remission/LDA and EULAR good response. Boolean remission and EULAR good/moderate response did not differ significantly between groups.
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Edifício Egas Moniz, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal ; Rheumatology Department, Hospital de Santa Maria, Lisbon Academic Medical Centre, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal.
authors.forename: Vasco C
authors.initials: VC
authors.lastname: Romão
authors.affiliation: Rheumatology Department, Hospital de Santa Maria, Lisbon Academic Medical Centre, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal ; Rheumatology Department, Hospital Garcia de Orta, Avenida Prof. Torrado da Silva, 2801-951 Almada, Portugal.
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Santos
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Edifício Egas Moniz, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal ; Rheumatology Department, Hospital de Santa Maria, Lisbon Academic Medical Centre, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Polido-Pereira
authors.affiliation: Rheumatology Department, Centro Hospitalar Universitário de Coimbra, Praceta Mota Pinto, 3000-076 Coimbra, Portugal.
authors.forename: Cátia
authors.initials: C
authors.lastname: Duarte
authors.affiliation: Rheumatology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Rua da Junqueira 126, 1349-019 Lisboa, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Nero
authors.affiliation: Rheumatology Department, Instituto Português de Reumatologia, R. Beneficência 7, 1050-034 Lisboa, Portugal.
authors.forename: Cláudia
authors.initials: C
authors.lastname: Miguel
authors.affiliation: Rheumatology Department, Unidade Local de Saúde do Alto Minho, Hospital Conde de Bertiandos, Largo Conde de Bertiandos, 4990-041 Ponte de Lima, Portugal.
authors.forename: José António
authors.initials: JA
authors.lastname: Costa
authors.affiliation: Rheumatology Department, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Miguel
authors.identifier: 0000-0002-1849-5465
authors.initials: M
authors.lastname: Bernardes
authors.affiliation: Rheumatology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Rua da Junqueira 126, 1349-019 Lisboa, Portugal ; CEDOC, NOVA Medical School, Nova University, Campo dos Mártires da Pátria 130, 1169-056 Lisboa, Portugal.
authors.forename: Fernando M
authors.initials: FM
authors.lastname: Pimentel-Santos
authors.affiliation: Rheumatology Department, Instituto Português de Reumatologia, R. Beneficência 7, 1050-034 Lisboa, Portugal.
authors.forename: Filipe
authors.initials: F
authors.lastname: Barcelos
authors.affiliation: Rheumatology Department, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Lúcia
authors.initials: L
authors.lastname: Costa
authors.affiliation: Rheumatology Department, Instituto Português de Reumatologia, R. Beneficência 7, 1050-034 Lisboa, Portugal.
authors.forename: José António
authors.initials: JA
authors.lastname: Melo Gomes
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Edifício Egas Moniz, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal.
authors.forename: José Alberto
authors.initials: JA
authors.lastname: Pereira da Silva
authors.affiliation: Rheumatology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Rua da Junqueira 126, 1349-019 Lisboa, Portugal ; CEDOC, NOVA Medical School, Nova University, Campo dos Mártires da Pátria 130, 1169-056 Lisboa, Portugal.
authors.forename: Jaime
authors.initials: J
authors.lastname: Cunha Branco
authors.affiliation: Rheumatology Department, Hospital Garcia de Orta, Avenida Prof. Torrado da Silva, 2801-951 Almada, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Canas da Silva
authors.affiliation: Rheumatology Department, Centro Hospitalar Universitário de Coimbra, Praceta Mota Pinto, 3000-076 Coimbra, Portugal.
authors.forename: José António
authors.initials: JA
authors.lastname: Pereira da Silva
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Edifício Egas Moniz, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal ; Rheumatology Department, Hospital de Santa Maria, Lisbon Academic Medical Centre, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal.
authors.forename: João Eurico
authors.initials: JE
authors.lastname: Fonseca
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Edifício Egas Moniz, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal ; Rheumatology Department, Hospital de Santa Maria, Lisbon Academic Medical Centre, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Canhão
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011174:Portugal; D012042:Registries; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; C502936:tocilizumab