title: Glucocorticoid-sparing in patients suffering from rheumatoid arthritis and treated with tocilizumab: the SPARE-1 study.
abstract: OBJECTIVE
  To describe steroid-sparing in rheumatoid arthritis (RA) patients treated with tocilizumab (TCZ).
  
  
  METHODS
  To evaluate the proportion of RA patients treated with more than 5 mg of prednisone (or equivalent)/day and starting TCZ who can receive less than 5 mg/day after 12 months without intensification of disease-modifying anti-rheumatic drugs (DMARDs), we conducted a non-interventional, multicentre, prospective study from 2011 to 2013. We included patients with moderate-to-severe RA, >18 years old, starting TCZ and receiving corticosteroids (GCs) at a dose greater than 5 mg/day of prednisone for at least 3 months.
  
  
  RESULTS
  Amongst the 307 analysed patients (78% women, median RA duration: 8 years, mean DAS28-ESR: 5.1±1.3), 40% (95%CI=[35-46]) reached the targeted daily prednisone dose at M12, without conventional synthetic (cs)DMARD intensification. Predictive factors were RA duration of 5 years or less (OR=2.60, p=0.01), daily prednisone dose of 7.5 mg or less (OR=2.12, p=0.03), and low ESR value before the first TCZ infusion (OR=0.86, p=0.047). The proportion of patients with no more GCs increased up to 20% at M12. Disease activity improved over the 1-year period (DAS28-ESR LDA and remission in 41% and 33% of patients at M12, respectively). Amongst the 314 patients analysed for safety, at least one AE and at least one SAE were reported in 211 patients (67%) and in 48 patients (15%), respectively. No unexplained safety signal arose with TCZ.
  
  
  CONCLUSIONS
  A biological DMARD as TCZ allows reducing both GCs dose and disease activity in RA patients. Nevertheless, corticosteroid spare in real life is probably lower.
authors.affiliation: La Cavale Blanche Hospital, Rheumatology and Université Bretagne Occidentale, Brest; and EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, Brest, France. alain.saraux@univ-brest.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.affiliation: eXYSTAT SAS, Levallois-Perret, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Rouanet
authors.affiliation: Roger Salengro Hospital, Rheumatology, Lille, France.
authors.forename: René-Marc
authors.initials: RM
authors.lastname: Flipo
authors.affiliation: Rheumatologist, private office, Gap, France.
authors.forename: Jean-Cyril
authors.initials: JC
authors.lastname: Poncet
authors.affiliation: Rheumatology, Nord Hospital, Amiens, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Fardellone
authors.affiliation: Department of Rheumatology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Hilliquin
authors.affiliation: Chugai, Medical Department, Puteaux, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Idier
authors.affiliation: Rheumatology, Purpan Hospital, Toulouse, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cantagrel
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; D011241:Prednisone / Q000627:therapeutic use*; D011446:Prospective Studies
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab; D011241:Prednisone