title: Rapid improvement of Clinical Disease Activity Index (CDAI) at 3 months predicts a preferable CDAI outcome at 1 year in active rheumatoid arthritis patients treated with tocilizumab: results from an observational investigation of daily clinical practice.
abstract: OBJECTIVE
  To investigate whether the Clinical Disease Activity Index (CDAI) at three months predicts a preferable CDAI outcome at one year in patients with active rheumatoid arthritis (RA) treated with tocilizumab (TCZ).
  
  
  METHODS
  Seventy-eight RA patients in the Nagasaki Prefecture, Japan, whose disease activities at baseline were moderate to high as estimated by the CDAI and who had received 8 mg/kg of TCZ every four weeks, were consecutively enrolled in this study from April 2008 to March 2011. The association of the CDAI at three months with that at one year was examined by the Cochran-Armitage test. The variables at baseline and at three months that were predictive of remission or low disease activity (LDA) according to the CDAI at one year were assessed by logistic regression analysis.
  
  
  RESULTS
  Most of the patients (40 out of 44: 91%), whose CDAI at three months showed remission or LDA continued to show remission or LDA at one year. Disease activity at three months significantly correlated with the frequency of LDA or remission at one year (p<0.0001). Logistic regression analysis revealed that only remission or LDA at three months as determined by the CDAI was predictive of remission or LDA at one year as determined by the CDAI (odds ratio 33.2, p<0.0001).
  
  
  CONCLUSIONS
  A preferable clinical outcome as estimated by the CDAI at one year in active RA patients treated with TCZ is predicted by the CDAI at three months, suggesting that the treat-to-target strategy carried out using the CDAI can be used in clinical practice in these patients.
authors.affiliation: Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; and Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. shin-ya@hotmail.co.jp.
authors.forename: Shin-Ya
authors.initials: SY
authors.lastname: Kawashiri
authors.affiliation: Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Nishino
authors.affiliation: Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Nakashima
authors.affiliation: Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Horai
authors.affiliation: Sasebo Chuo Hospital, Center for Rheumatic Disease, Sasebo, Japan.
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Ueki
authors.affiliation: Sasebo Chuo Hospital, Center for Rheumatic Disease, Sasebo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Aramaki
authors.affiliation: Department of Rheumatology, Isahaya General Hospital, Isahaya, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Fujikawa
authors.affiliation: Department of Internal Medicine, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan.
authors.forename: Munetoshi
authors.initials: M
authors.lastname: Nakashima
authors.affiliation: Department of Internal Medicine, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan.
authors.forename: Akitomo
authors.initials: A
authors.lastname: Okada
authors.affiliation: Department of General Internal Medicine, NHO National Nagasaki Medical Centre, Omura, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Migita
authors.affiliation: Department of Rheumatology, Isahaya General Hospital, Isahaya, Japan.
authors.forename: Akinari
authors.initials: A
authors.lastname: Mizokami
authors.affiliation: Nagasaki Medical Hospital of Rheumatology, Nagasaki, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Matsuoka
authors.affiliation: Suga Orthopaedic Hospital, Centre for Rheumatic Disease, Isahaya, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Mine
authors.affiliation: Department of Internal Medicine, Sadamatsu Hospital, Omura, Japan.
authors.forename: Soko
authors.initials: S
authors.lastname: Sakito
authors.affiliation: Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Iwamoto
authors.affiliation: Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Ichinose
authors.affiliation: Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Mami
authors.initials: M
authors.lastname: Tamai
authors.affiliation: Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Origuchi
authors.affiliation: Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Aoyagi
authors.affiliation: Sasebo City General Hospital, Sasebo, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Eguchi
authors.affiliation: Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawakami
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab