Monoclonal antibodies in rheumatoid arthritis: comparative effectiveness of tocilizumab with tumor necrosis factor inhibitors

Figures & data

Table 1 Characteristics of tocilizumab and tumor necrosis factor inhibitors

	Tocilizumab	Infliximab	Adalimumab	Golimumab	Certolizumab pegol	Etanercept
Target molecule	IL-6R	TNF-α	TNF-α	TNF-α	TNF-α	TNF-α Lymphotoxin
Structure	Humanized Ig	Chimeric Ig	Fully human Ig	Fully human Ig	Humanized Fab-pegol	P75TNFR-Fc
Injection route	IV, SC	IV	SC	SC	SC	SC
Activity
ADCC	+	+	+	+	−	+
CDCC	+	+	+	+	−	±

Abbreviations: ADCC, antibody-dependent cellular cytotoxicity; CDCC, complement-dependent cellular cytotoxicity; Ig, immunoglobulin; IL-6R, interleukin-6 receptor; IV, intravenously; SC, subcutaneously; TNF-α, tumor necrosis factor-α; TNFR, TNF receptor.

Figure 1 Indirect comparisons of the suppressive effects of tocilizumab and tumor necrosis factor inhibitors on radiographic damage.

Notes: Copyright © 2012. Adapted from Dove Medical Press. Jones G, Darian-Smith E, Kwok M, Winzenberg T. Effect of biologic therapy on radiological progression in rheumatoid arthritis: what does it add to methotrexate? Biologics. 2012;6:155–161.³⁰ In combination with methotrexate (MTX) compared with MTX alone, tocilizumab and all tumor necrosis factor inhibitors are effective at slowing X-ray progression. As monotherapy, adalimumab, etanercept, and tocilizumab are significantly better than MTX, whereas golimumab had no significant effect. The x-axis shows progression of radiographic damage.
Abbreviations: CI, confidence interval; MTX, methotrexate.

Table 2 Comparative tolerability of tocilizumab with tumor necrosis factor inhibitors

Registry name	Retention period	Drug survival rate (%)
		TCZ	IFX	ETA	ADA
CORRONA^Citation45	24 months		63	53	53
LOHREN^Citation46	2.5 years		56	72	57
SCQM-RA^Citation47	2.5 years		51	58	61
GISEA^Citation48	2.5 years		52	65	52
DANBIO^Citation49,Citation50	96 weeks	54
	48 months		41	56	52
BiRD^Citation51	2.5 years	79	47	78	55

Abbreviations: ADA, adalimumab; BiRD, Biologics for Rheumatic Diseases; CORRONA, Consortium of Rheumatology Researchers of North America; DANBIO, Danish Nationwide Rheumatological Database; ETA, etanercept; GISEA, Gruppo Italiano di Studio sulle Early Arthritides; IFX, infliximab; LOHREN, Lombardy Rheumatology Network; SCQM-RA, Swiss Clinical Quality Management for Rheumatoid Arthritis; TCZ, tocilizumab; TNF, tumor necrosis factor.

Figure 2 Properties of tocilizumab and tumor necrosis factor inhibitors in the management of rheumatoid arthritis.

Abbreviations: AEs, adverse events; CRP, C-reactive protein; GI, gastrointestinal; MTX, methotrexate; SAA, serum amyloid A; TB, tuberculosis; T-CHO, total cholesterol.

Figure 3 Selection of biologic disease modifying antirheumatic drugs.

Notes: Rheumatoid arthritis patients who fail to respond to methotrexate (MTX) alone or in combination with other synthetic disease modifying antirheumatic drugs (DMARDs) need to be treated with a biologic DMARD. For patients who can continue to receive MTX, any of the seven biologic DMARDs should be selected. These include five tumor necrosis factor inhibitors (infliximab, etanercept, adalimumab, golimumab, and certolizumab pegol), the IL-6 receptor blocker tocilizumab, the T-cell stimulation blocker abatacept, and the B-cell depletory rituximab. Rituximab is recommended to be used for patients who have certain contraindications for other agents such as a recent history of lymphoma, latent tuberculosis with contraindications to the use of chemoprophylaxis, live in a tuberculosis endemic region, or a previous history of demyelinating disease. Tocilizumab may be selected for patients who 1) cannot continue treatment with MTX or other synthetic DMARDs, 2) present with severe inflammatory findings, and 3) have or who are at high risk of developing amyloid A amyloidosis.
Abbreviations: ABA, abatacept; ADA, adalimumab; CEP, certolizumab pegol; DMARDs, disease modifying antirheumatic drugs; ETA, etanercept; GOL, golimumab; IFX, infliximab; MTX, methotrexate; RTX, rituximab; TCZ, tocilizumab.

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