Retention of Subcutaneous vs Intravenous Tocilizumab in Rheumatoid Arthritis

doctor filling syringe
doctor filling syringe
Investigators compared the effectiveness of subcutaneous vs intravenous tocilizumab in rheumatoid arthritis.

Compared with intravenous tocilizumab, subcutaneous tocilizumab has similar retention and effectiveness in patients with rheumatoid arthritis (RA), according to study results published in RMD Open.

The study included participants with RA taking tocilizumab from 8 European registries. The researchers compared drug retention using unadjusted Kaplan-Meier and Cox models adjusted for baseline participant disease and treatment characteristics using a strata term for year of treatment initiation and country of registry. They compared the percentage of participants who achieved Clinical Disease Activity Index (CDAI) remission and low disease activity (LDA) at 1 year.

Of 3448 participants, 2414 received intravenous tocilizumab and 1034 received subcutaneous tocilizumab. The researchers calculated a crude median retention of 3.52 years for intravenous tocilizumab  and 2.12 years for subcutaneous tocilizumab.

After stratifying for country and year of treatment initiation and adjusting for covariates, the researchers found that hazards of discontinuation were similar in patients treated with subcutaneous and intravenous tocilizumab (hazard ratio [HR], 0.93; 95% CI, 0.80-1.09).

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The results indicated that the average adjusted CDAI change at 1 year was similar in both groups (−6.08). After matching 560 participants from each group, CDAI remission corrected for attrition at 1 year was similar in both groups (10.4% in intravenous tocilizumab vs 12.8% in subcutaneous tocilizumab). However, CDAI LDA was lower in participants treated with intravenous tocilizumab (41.0%) compared with participants treated with subcutaneous tocilizumab (49.1%).

“When possible, considering the costs of the intravenous route, subcutaneous tocilizumab should be the preferred mode of administration,” the researchers wrote.

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Lauper K, Mongin D, Iannone F, et al. Comparative effectiveness of subcutaneous tocilizumab versus intravenous tocilizumab in a pan-European collaboration of registries [published online November 5, 2018]. RMD Open. doi:10.1136/rmdopen-2018-000809