Subcutaneous Tocilizumab Effective in DMARD-Treated Rheumatoid Arthritis

RA hands
RA hands
The safety and efficacy of subcutaneous tocilizumab was examined in the BREVACTA study.

In patients with rheumatoid arthritis (RA) who have experienced little benefit from disease-modifying antirheumatic drugs (DMARDs), subcutaneous tocilizumab (TCZ) appears to be well tolerated and associated with an American College of Rheumatology (ACR) response, according to a randomized study published in the Journal of Rheumatology.

Patients with RA were randomly assigned in a 2:1 ratio to receive either 162 mg subcutaneous TCZ every 2 weeks (n=437) or subcutaneous placebo every 2 weeks plus DMARDs (n=219) for a total of 2 years. Investigators performed a second randomization after a 24-week double-blind period in which patients received either open-label subcutaneous TCZ every 2 weeks (n=338) or placebo (n=119) groups. At 12 weeks after re-randomization, participants with inadequately controlled RA disease activity had the option to receive escape therapy with weekly subcutaneous TCZ.

At each point, there was a >70% ACR response in patients receiving TCZ subcutaneously, and the response was maintained beyond 24 weeks. There was a ≥0.30 decrease from baseline in the Health Assessment Questionnaire-Disability Index response rates after 24 weeks of subcutaneous TCZ treatment (>56%), and the 28-joint Disease Activity Score remission and ACR 50 and ACR 70 response rates were also maintained beyond 24 weeks (>32%, ≥50%, and >25%, respectively).

At 2 years, approximately 35% of patients from the subcutaneous TCZ group and 63% from the placebo group achieved an ACR 20 response after escape therapy. Investigators also observed a stable rate of serious adverse events through 96 weeks in the treatment group (11.20/100 patient-years).

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This study also showed that escape therapy from subcutaneous TCZ every 2 weeks to subcutaneous TCZ every week had improved ACR responses, suggesting “that some patients who did not respond or only partially responded to TCZ-SC [every 2 weeks] may benefit from more frequent dosing.”


Kivitz A, Olech E, Borofsky MA, et al. Two-year efficacy and safety of subcutaneous tocilizumab in combination with disease-modifying antirheumatic drugs including escalation to weekly dosing in rheumatoid arthritis [published online December 15, 2017]. J Rheumatol. doi:10.3899/jrheum.161539