Initiating a tocilizumab-based treat-to-target strategy in disease-modifying antirheumatic drug (DMARD)-naive patients with early rheumatoid arthritis is more effective in preventing progression of disease than a step-up methotrexate (MTX) strategy, particularly in the feet, according to a phase 3 study published in Rheumatology.

Researchers randomly assigned 317 DMARD-naive patients with early rheumatoid arthritis to receive either tocilizumab 8 mg/kg given intravenously every 4 weeks up to a maximum of 800 mg/dose, or oral MTX started at 10 mg/week and increased stepwise by 5 mg every 4 weeks to 30 mg/week, or a combination of the two. Patients were treated to target until sustained remission was achieved. Radiographs were scored at baseline and after 52 and 104 weeks.

No differences in joint space narrowing were observed between the therapies (P ³0.09) at both 52 and 104 weeks. However, erosion progression scores were significantly lower at 104 weeks in patients who received tocilizumab compared with patients who received MTX (P ≤0.023). At the same time point, significantly less progression of erosion in the feet (P ≤0.046) but not in the hands (P ³0.11) was documented in patients who received tocilizumab. Compared with patients who received MTX alone, the tocilizumab groups had a higher proportion of patients who did not have progression in erosion at weeks 52 and 104.


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Investigators believe this is the first study of its kind. Fewer erosions were found in DMARD-naive patients with early rheumatoid arthritis who received treat-to-target tocilizumab therapy, with or without MTX, compared with a step-up MTX strategy. The authors noted that, “especially in the feet, we found less erosion in the tocilizumab-based strategies, showing that by rapidly reducing inflammation, the functional ability can be preserved in newly diagnosed patients.”

Reference

Teitsma XM, Jacobs JWG, Welsing PMJ, et al. Radiographic joint damage in early rheumatoid arthritis patients: comparing tocilizumab- and methotrexate-based treat-to-target strategies [published online October 31, 2017]. Rheumatology (Oxford). doi:10.1093/rheumatology/kex386