Tocilizumab monotherapy and combination therapy are effective treatment options for patients with rheumatoid arthritis (RA) and a history of inadequate response to at least 1 biologic disease-modifying antirheumatic drug (bDMARD), according to results published in the Annals of the Rheumatic Diseases.

The results of this study indicated that tocilizumab monotherapy or combination therapy had significantly longer drug retention and similar efficacy compared with tumor necrosis factor inhibitors.

The study included participants with RA who had used at least 1 bDMARD. The researchers compared drug retention using Kaplan-Meier and Cox models, as well as Clinical Disease Activity Index (CDAI) change over time with mixed-effects models for longitudinal data. They used LUNDEX correction to compare the proportions of CDAI remission and low disease activity at 1 year.

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The researchers analyzed 771 participants receiving tocilizumab as monotherapy (TCZ mono), 1773 receiving tocilizumab combination therapy (TCZ combo), 1404 receiving tumor necrosis factor inhibitors as monotherapy (TNFi mono), and 4660 in combination tumor necrosis factor inhibitor therapy (TNFi combo).

Participants in the TCZ mono group and the TCZ combo group had higher median retention (2.31 years [95% CI, 2.07-2.61] and 1.98 years [95% CI, 1.83-2.11], respectively) compared with participants in the TNFi combo group (1.37 years; 95% CI, 1.30-1.45) and TNFi mono group (1.31 years; 95% CI, 1.18-1.47).

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In a country and year of treatment initiation-stratified, covariate-adjusted analysis, the researchers found that hazards of discontinuation were significantly lower among participants in the TCZ mono or combo groups compared with participants in the TNFi mono or combo groups. The hazards were similar among participants in the TCZ mono and combo groups.

The researchers found that the average adjusted CDAI change was similar between groups, and CDAI remission and low disease activity rates were comparable between groups.


Lauper K, Nordstrom DC, Pavelka K, et al. Comparative effectiveness of tocilizumab versus TNF inhibitors as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis after the use of at least one biologic disease-modifying antirheumatic drug: analyses from the pan-European TOCERRA register collaboration [published online May 5, 2018]. Ann Rheum Dis. doi: 10.1136/ annrheumdis-2017-212845