Head-To-Head Comparison of Tocilizumab, Abatacept, Rituximab After Non-TNFi Failure in RA

HealthDay News –  A recent study has shown that patients with rheumatoid arthritis (RA) being treated with tocilizumab achieve lower Disease Activity Index of 28 joints-erythrocyte sedimentation rate (DAS28-ESR) scores compared to those treated with abatacept or rituximab after previous non-tumor necrosis factor inhibitor (TNFi) failure, according to a study published in the International Journal of Rheumatic Diseases.

Tristan Pascart, MD, from Lille University in Lomme, France, and colleagues conducted a retrospective, multicenter study involving patients treated for RA with abatacept, rituximab, or tocilizumab after a non-TNFi failure. Data were collected for 100 patients who started a second non-TNFi between 2006 and 2013 (15 treated with rituximab, 36 with tocilizumab, and 49 with abatacept).

The researchers found that the change in DAS28-ESR differed significantly between the groups (P=.001). The decrease in DAS28-ESR was higher for patients treated with tocilizumab versus abatacept (median, 36% vs 0%; P .002). 

A similar difference was seen for tocilizumab and rituximab, although the difference was not significant (median decrease, 36% vs 0%; P=.07). The results were similar for 12-month change in DAS28-C-reactive protein.

“This study suggests a better efficacy of tocilizumab compared with abatacept and rituximab in situations of non-TNFi failure,” the authors write.

Several authors disclosed financial ties to the pharmaceutical and medical technology industries.

Summary and Clinical Applicability

This study suggests that patients with RA who have failed to respond to prior  first TNFi therapy achieve better disease control with tocilizumab as compared to abatacept and ritixumab when assessed with DAS28-ESR.

“Our study provides the first comparison of efficacy between non-TNFi agents. Such results are essential to guide therapeutic decision-making on the appropriate follow-on treatment once a non-TNFi has failed,” the authors conluded.

These study results were limited by the retrospective nature of this study and the limited statistical power due to the small sample size. Evaluation of the persistence of these effects beyond the examined study period would have to be determined.


Pascart T, Philippe P, Drumez E, et al. Comparative efficacy of tocilizumab, abatacept and rituximab after non-TNF inhibitor failure: results from a multicentre study. Int J Rheum Dis. 2016; Epub ahead of print March 27, 2016. doi: 10.1111/1756-185X.12845