title: Clinical and structural remission rates increased annually and radiographic progression was continuously inhibited during a 3-year administration of tocilizumab in patients with rheumatoid arthritis: A multi-center, prospective cohort study by the Michinoku Tocilizumab Study Group.
abstract: OBJECTIVE
  To evaluate the clinical and structural efficacy of tocilizumab (TCZ) during its long-term administration in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  In total, 693 patients with RA who started TCZ therapy were followed for 3 years. Clinical efficacy was evaluated by DAS28-ESR and Boolean remission rates in 544 patients. Joint damage was assessed by calculating the modified total Sharp score (mTSS) in 50 patients.
  
  
  RESULTS
  When the reason for discontinuation was limited to inadequate response or adverse events, the 1-, 2-, and 3-year continuation rates were 84.0%, 76.8%, and 72.2%, respectively. The mean DAS28-ESR was initially 5.1 and decreased to 2.5 at 6 months and to 2.2 at 36 months. The Boolean remission rate was initially 0.9% and increased to 21.7% at 6 months and to 32.2% at 36 months. The structural remission rates (ΔmTSS/year ≤ 0.5) were 68.8%, 78.6%, and 88.9% within the first, second, and third years, respectively. The structural remission rate at 3 years (ΔmTSS ≤ 1.5) was 66.0%, and earlier achievement of swollen joint count (SJC) of 1 or less resulted in better outcomes.
  
  
  CONCLUSIONS
  TCZ was highly efficacious, and bone destruction was strongly prevented. SJC was an easy-to-use indicator of joint destruction.
authors.affiliation: a Department of Rheumatology , Hikarigaoka Spellman Hospital , Sendai , Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hirabayashi
authors.affiliation: b Munakata Yasuhiko Clinic , Sendai , Japan.
authors.forename: Yasuhiko
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authors.lastname: Munakata
authors.affiliation: c Department of Internal Medicine , Fukushima Red Cross Hospital , Fukushima , Japan.
authors.forename: Masayuki
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authors.affiliation: d Department of Rheumatology , Tsugaru General Hospital , Gosyogawara , Japan.
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authors.affiliation: e Suminoya Rheumatism & Orthopedics Clinic , Iwaki , Japan.
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authors.affiliation: f Department of Orthopaedic Surgery , Tohoku University Graduate School of Medicine , Sendai , Japan.
authors.forename: Hiroshi
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authors.affiliation: g Yoshida Orthopaedic Surgery and Rheumatology Clinic , Morioka , Japan.
authors.forename: Masaaki
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authors.affiliation: h Center for Arthritis and Rheumatic Diseases, Tohoku Pharmaceutical University Hospital , Sendai , Japan.
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authors.affiliation: i Department of Hematology and Rheumatology , Tohoku University Graduate School of Medicine , Sendai , Japan.
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authors.affiliation: j Department of Orthopaedic Surgery , Nakadori General Hospital , Akita , Japan.
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authors.affiliation: r Department of Hematology, Nephrology, and Rheumatology , Akita University Hospital , Akita , Japan.
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authors.affiliation: v Department of Orthopaedic Surgery , Hirosaki Memorial Hospital , Hirosaki , Japan.
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authors.forename: Kazunobu
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authors.affiliation: x Department of Cardiology, Pulmonology, and Nephrology , Yamagata University Faculty of Medicine , Yamagata , Japan.
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authors.affiliation: i Department of Hematology and Rheumatology , Tohoku University Graduate School of Medicine , Sendai , Japan.
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authors.affiliation: aa Department of Gastroenterology and Rheumatology , Fukushima Medical University Hospital , Fukushima , Japan.
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mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction / Q000379:methods; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab
keywords: Joint destruction; Long-term administration; Real clinical practice; Rheumatoid arthritis; Tocilizumab