title: Predictive factors for induction of remission in patients with active rheumatoid arthritis treated with tocilizumab in clinical practice.
abstract: OBJECTIVE
  To identify predictors of early response to tocilizumab (TCZ) in patients with active rheumatoid arthritis (RA) seen in daily routine clinical practice.
  
  
  METHODS
  A multicenter ambispective observational study of 126 RA patients treated with TCZ as a first- or second-line biological therapy. The variables associated to achieve the therapeutic goal (remission defined as a DAS28-ESR < 2.6) at 3 and 6 months were identified using regression analysis.
  
  
  RESULTS
  TCZ was administered as the first biologic in 26% of patients. Overall, 34% of patients received TCZ as monotherapy. EULAR response and remission were obtained in 82% and 31% of patients at 3 months and in 86% and 40% at 6 months. In the multivariate analysis, the predictive factors increasing the likelihood of clinical remission at 3 months were baseline ESR > 30 mm/h (OR = 19.07, 95% CI: 2.720-133.716), baseline CRP > 10 mg/L (OR = 4.95; 95% CI: 1.464-13.826), and the presence of extra-articular manifestations of the disease (OR = 15.45, 95% CI: 2.334-102.319). The factors that decreased it were higher concentrations of hemoglobin (OR = 0.53, 95% CI: 0.319-0.910), higher baseline DAS28-ESR (OR = 0.30, 95% CI: 0.145-0.635) and the number of previous DMARDs (OR = 0.41, 95% CI: 0.221-0.779), and biological therapies used (OR = 0.33, 95% CI: 0.155-0.734). The only factor that remained statistically significant at 6 months was higher baseline DAS28-ESR (OR = 0.55, 95% CI: 0.347-0.877). No relationship was found with the neutrophil count or with the RF or ACPA positivity.
  
  
  CONCLUSIONS
  In routine clinical practice, strong acute phase response, the presence of extra-articular manifestations, and the number of previous DMARDs and biological therapies used may help to identify patients who will have a rapid response to TCZ. However, it is likely that no parameter will predict response if taken separately.
authors.affiliation: Department of Rheumatology (Planta 10-2), Hospital Universitario de Bellvitge-IDIBELL, Feixa Llarga, s/n. Hospitalet de Llobregat, Barcelona 08907, Spain. Electronic address: fjnarvaez@bellvitgehospital.cat.
authors.forename: Javier
authors.initials: J
authors.lastname: Narváez
authors.affiliation: Rheumatology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Berta
authors.initials: B
authors.lastname: Magallares
authors.affiliation: Rheumatology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: César
authors.initials: C
authors.lastname: Díaz Torné
authors.affiliation: Department of Rheumatology, Hospital Clínic de Barcelona-IDIBAPS, Barcelona, Spain.
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Hernández
authors.affiliation: Deparment of Rheumatology, Hospital de Sant Joan Despí, Consorci Sanitari Integral, Barcelona, Spain.
authors.forename: Delia
authors.initials: D
authors.lastname: Reina
authors.affiliation: Deparment of Rheumatology, Hospital de Sant Joan Despí, Consorci Sanitari Integral, Barcelona, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Corominas
authors.affiliation: Department of Rheumatology, Hospital Clínic de Barcelona-IDIBAPS, Barcelona, Spain.
authors.forename: Raimon
authors.initials: R
authors.lastname: Sanmartí
authors.affiliation: Rheumatology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: LLobet
authors.affiliation: Rheumatology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Rodriguez de la Serna
authors.affiliation: Department of Rheumatology (Planta 10-2), Hospital Universitario de Bellvitge-IDIBELL, Feixa Llarga, s/n. Hospitalet de Llobregat, Barcelona 08907, Spain.
authors.forename: Joan Miquel
authors.initials: JM
authors.lastname: Nolla
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*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab
keywords: Predictors of response; Remission; Rheumatoid arthritis; Tocilizumab