Tocilizumab Treat-to-Target More Efficacious Than Methotrexate in RA

Treatment Selection in Rheumatoid Arthritis
Treatment Selection in Rheumatoid Arthritis
DMARD-naïve patients with rheumatoid arthritis benefited from treat-to-target tocilizumab therapy.

A tocilizumab treat-to-target approach in DMARD-naïve patients with early rheumatoid arthritis (RA) was shown to lower erosion progression scores compared with treat-to-target methotrexate, according to the results of a recent study published in Rheumatology.

Researchers randomly assigned newly-diagnosed DMARD-naïve patients with RA to receive tocilizumab (n=103), step-up methotrexate alone (n=108), or a combination of tocilizumab and step-up methotrexate (n=106). Radiographic progression was evaluated with Sharp-van der Heijde erosion and joint space narrowing (JSN) scores at 52 and 104 weeks.

Overall, mean erosion and JSN scores increased at 52 weeks (0.59 and 0.18, respectively) and at 104 weeks (0.70 and 0.50).

At week 104, erosion scores were significantly lower in both tocilizumab groups compared with methotrexate alone (P <.02). When compared by body region, the researchers noted that there was reduced progression of erosions of the feet in the tocilizumab groups compared with the methotrexate alone group (P <.046), whereas no significant difference between groups was noted for erosions of the hands (P >.1).

The researchers noted no differences in progression of JSN scores in the 3 treatment groups (P >.09).

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At week 52, more patients in the tocilizumab-only group (81%) and combination therapy group (87%) had no erosion progression compared with the methotrexate-only group (74%; P =.3 and P =.04, respectively). Similar results were reported at week 104, with no progression occurring in 77% of tocilizumab-only (P =.03 compared with methotrexate), 85% of combination therapy (P =.001), and 60% of methotrexate-only patients.

The study investigators concluded that “this study demonstrates that initiating a treat-to-target tocilizumab therapy, with or without [methotrexate], in DMARD-naïve patients with early RA is more effective in preventing progression of erosions compared with a step-up [methotrexate] strategy.”

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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