title: Effectiveness of tocilizumab with and without synthetic disease-modifying antirheumatic drugs in rheumatoid arthritis: results from a European collaborative study.
abstract: To examine the effectiveness of tocilizumab (TCZ) with and without synthetic disease-modifying antirheumatic drugs (sDMARDs) in a large observational study.
  
  
  
  Patients with rheumatoid arthritis treated with TCZ who had a baseline visit and information on concomitant sDMARDs were included. According to baseline data, patients were considered as taking TCZ as monotherapy or combination with sDMARDs. Main study outcomes were the change of Clinical Disease Activity Index (CDAI) and TCZ retention. The prescription of TCZ as monotherapy was analysed using logistic regression. CDAI change was analysed with a mixed-effects model for longitudinal data. TCZ retention was analysed with a stratified extended Cox model.
  
  
  
  Multiple-adjusted analysis suggests that prescription of TCZ as monotherapy varied according to age, corticosteroid use, country of the registry and year of treatment initiation. The change of disease activity assessed by CDAI as well as the likelihood to be in remission were not significantly different whether TCZ was used as monotherapy or in combination with sDMARDs in a covariate-adjusted analysis. Estimates for unadjusted median TCZ retention were 2.3 years (95% CI 1.8 to 2.7) for monotherapy and 3.7 years (lower 95% CI limit 3.1, upper limit not estimable) for combination therapies. In a covariate-adjusted analysis, TCZ retention was also reduced when used as monotherapy, with an increasing difference between mono and combination therapy over time after 1.5 years (p=0.002).
  
  
  
  TCZ with or without concomitant sDMARDs resulted in comparable clinical response as assessed by CDAI change, but TCZ retention was shorter under monotherapy of TCZ.
authors.affiliation: Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Cem
authors.initials: C
authors.lastname: Gabay
authors.affiliation: SCQM Foundation, Zurich, Switzerland.
authors.forename: Myriam
authors.initials: M
authors.lastname: Riek
authors.affiliation: DANBIO, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark.
authors.forename: Merete Lund
authors.initials: ML
authors.lastname: Hetland
authors.affiliation: Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Ellen-Margrethe
authors.initials: EM
authors.lastname: Hauge
authors.affiliation: Institute of Rheumatology and Clinic of Rheumatology, Charles University Prague, Prague, Czech Republic.
authors.forename: Karel
authors.initials: K
authors.lastname: Pavelka
authors.affiliation: University Medical Center, Ljubljana, Slovenia.
authors.forename: Matija
authors.initials: M
authors.lastname: Tomšič
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal, on behalf of the Rheumatic Diseases Portuguese Register (Reuma.pt).
authors.forename: Helena
authors.initials: H
authors.lastname: Canhao
authors.affiliation: The Karolinska Institute, Stockholm, Sweden.
authors.forename: Katerina
authors.initials: K
authors.lastname: Chatzidionysiou
authors.affiliation: Institute of Rheumatology, Moscow, Russia.
authors.forename: Galina
authors.initials: G
authors.lastname: Lukina
authors.affiliation: Department of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Dan C
authors.initials: DC
authors.lastname: Nordström
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lie
authors.affiliation: Cantacuzino Hosp, Bucharest, Romania.
authors.forename: Ioan
authors.initials: I
authors.lastname: Ancuta
authors.affiliation: Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: M Victoria
authors.initials: MV
authors.lastname: Hernández
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Piet L M C
authors.initials: PL
authors.lastname: van Riel
authors.affiliation: The Karolinska Institute, Stockholm, Sweden.
authors.forename: Ronald
authors.initials: R
authors.lastname: van Vollenhoven
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab
keywords: DMARDs (biologic); DMARDs (synthetic); Rheumatoid Arthritis; Treatment