Predictive factors for induction of remission in patients with active rheumatoid arthritis treated with tocilizumab in clinical practice

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• 作者：Javier Narvá ; ez ; PhD^a ; ^{fjnarvaez@bellvitgehospital.cat" class="auth_mail" title="E-mail the corresponding author} ; ^{31577edd@comb.cat" class="auth_mail" title="E-mail the corresponding author} ; Berta Magallares ; MD^b ; Cé ; sar Dí ; az Torné ; MD ; PhD^b ; Maria Victoria Herná ; ndez ; MD ; PhD^c ; Delia Reina ; MD^d ; Hé ; ctor Corominas ; MD ; PhD^d ; Raimon Sanmartí ; MD ; PhD^c ; Josep Maria LLobet ; MD^b ; Arturo Rodriguez de la Serna ; MD ; PhD^b ; Joan Miquel Nolla ; MD ; PhD^a
• 关键词：ACR ; American College of Rheumatology ; ACPA ; anti-citrullinated peptide antibodies ; CI ; confidence interval ; CRP ; C-reactive protein ; DAS ; disease activity score ; DMARD ; disease modifying anti-rheumatic drug ; ESR ; erythrocyte sedimentation rate ; EULAR ; European League against Rheumatism ; HAQ ; Health Assessment Questionnaire ; IL-6 ; interleukin-6 ; OR ; odds ratio ; RA ; rheumatoid arthritis ; TNF ; tumor necrosis factor ; TCZ ; tocilizumab ; WBC ; white blood cell
• 刊名：Seminars in Arthritis and Rheumatism
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：45
• 期：4
• 页码：386-390
• 全文大小：237 K

文摘

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.

Conclusion

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.