Effect of interleukin-6 receptor inhibitor, tocilizumab, in preventing joint destruction in patients with rheumatoid arthritis showing inadequate response to TNF inhibitors

Abstract

Objectives. To examine the effectiveness of tocilizumab (TCZ) in preventing joint destruction in patients with inadequate response to tumor necrosis factor inhibitors (TNF-IR) by assessing X-rays.

Methods. RA patients were extracted from the Retrospective actemra investigation for optimal needs of RA patients (REACTION) study. Parameters and components of disease activity were evaluated during anti-TNF treatment and during TCZ treatment. X-ray images of hands and feet at the beginning of this study during anti-TNF treatment (Pre), at the start point of TCZ treatment (Baseline) and after TCZ treatment (Post) were collected for assessing joint destruction.

Results. Forty-five patients from the REACTION study fulfilled the criteria of clinical TNF-IR. During anti-TNF treatment, mean DAS28-ESR rose from 5.35 to 5.87 (mean observation duration, 16 months) but improved significantly to 2.94 (P < 0.0001) at 52 weeks after switching to TCZ. Mean change in van der Heijde-modified Sharp score (TSS) during anti-TNF treatment was 3.17 in this TNF-IR population. After switching to TCZ, mean change in TSS was 1.20 (P < 0.05). Rate of radiographic non-progression improved to 66.7% during TCZ treatment from 40.0% during anti-TNF treatment. The predictive factor for no radiographic progression after switching to TCZ was a HAQ disability index (HAQ-DI) score of ≤ 1.88 at switching to TCZ.

Conclusion. TCZ was a good treatment option for improving signs and symptoms and inhibiting progression of joint damage in patients with clinical and structural TNF-IR.

Keywords:

• Joint destruction
• Rheumatoid arthritis
• Switching
• TNF inhibitor
• Tocilizumab

Acknowledgments

The authors thank all medical staff in all institutions for providing the data.

Funding

This work was supported in part by a Research Grant-In-Aid for Scientific Research from the Ministry of Health, Labor and Welfare of Japan, and the Ministry of Education, Culture, Sports, Science and Technology of Japan.

Conflict of interest

YT has received consulting fees, speaking fees and/or honoraria from Mitsubishi-Tanabe Pharma, Eisai, Chugai Pharma, Abbott Japan, Astellas Pharma, Daiichi-Sankyo, Abbvie, Janssen Pharma, Pfizer, Takeda Pharma, Astra-Zeneca, Eli Lilly Japan, GlaxoSmithKline, Quintiles, MSD, Asahi-Kasei Pharama and has received research grants from Bristol-Myers, Mitsubishi-Tanabe Pharma, Abbvie, MSD, Chugai Pharma, Astellas Pharma, Daiichi-Sankyo. TT has received grants from Abbott Japan, Astellas Pharma, Bristol-Myers, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Janssen Pharma, Mitsubishi Tanabe Pharma, Nippon Shinyaku, Otsuka Pharma, Pfizer Japan, Sanofi-Aventis, Santen Pharma, Takeda Pharma, and Teijin Pharma, speaking fees from Abbott Japan, Bristol-Myers, Chugai Pharma, Eisai, Janssen Pharma, Mitsubishi Tanabe Pharma Pfizer Japan, and Takeda Pharma, and consultant fees from Astra Zeneca, Eli Lilly Japan, Novartis Pharma, Mitsubishi Tanabe Pharma, and Asahi Kasei Medical. KA has received relevant research grants from Chugai Pharmaceutical. HK has received relevant consulting fees, speaking fees, and/or honoraria from Mitsubishi-Tanabe Pharma Corporation and has received research grants from Eisai and HY has received speaking fees from Abbott Japan, AstraZeneca, Bristol-Myers Squibb, Chugai Pharma, Daiichi Sankyo, Ltd., Eisai Janssen Pharma, Mitsubishi Tanabe Pharma, Otsuka Pharma, Pfizer Japan, Takeda Pharma, Teijin Pharma and UCB Japan.