Dropout due to inadequate effect of tocilizumab for rheumatoid arthritis in the Akita Orthopedic group on Rheumatoid Arthritis registry

Abstract

Objective: By assessing dropout of rheumatoid arthritis (RA) cases due to inadequate effect of Tocilizumab (TCZ) therapy in the Akita Orthopedic Group on Rheumatoid Arthritis registry, this study aimed to investigate more effective ways to use this drug.Subjects and methods: This study included 177 patients who were treated with TCZ, consisting of 95 treatment-naive patients (group N) and 82 patients switching to TCZ therapy (group S). We retrospectively collected data on patient characteristics, duration of treatment before discontinuation, treatment details after discontinuation, disease activity.Results: TCZ therapy was discontinued due to inadequate effect in 12 patients. Patient mean age was 58 years (range, 44-82 years). Mean disease duration was 120 months (range, 6-366 months). Group N included 4 patients, and group S included 8, all of whom switched from tumor necrosis factor (TNF) inhibitors. The mean duration of TCZ therapy before discontinuation was 30 months (range, 6-67 months). After discontinuation, TCZ was switched to other biopharmaceuticals in 10 patients, consisting of 2 patients who switched to TNF inhibitors and 8 who switched to abatacept (ABT). At the final evaluation, 3 patients switched to TNF inhibitors again. Clinical disease activity index (CDAI) was 20.3 ± 13.4 (mean ± standard deviation) at the start of therapy and 12.4 ± 8.1 at the time of discontinuation. Six patients achieved low disease activity (LDA). CDAI at the final evaluation was 9.5 ± 8.4. LDA was achieved in 8 patients.Conclusion: Dropout cases due to inadequate effect of TCZ for RA included many patients who switched from TNF inhibitors. TNF inhibitors and ABT can equally replace TCZ for dropout cases. TCZ can be more effectively and continuously used, based on comprehensive assessment of its effect.