Tocilizumab Effective After Methotrexate Discontinuation

Methotrexate discontinuation was not observed to impact rheumatoid arthritis treatment with tocilizumab, according to an abstract presented at the 2017 American College of Rheumatology Annual Meeting.

Patients with rheumatoid arthritis (RA) who discontinued methotrexate (MTX) saw no changes in efficacy compared with patients who remained on the combination of subcutaneous tocilizumab (TCZ) and MTX, according to results of a randomized, controlled trial.

“In patients who achieved low disease activity with TCZ + MTX, MRI changes were minimal and showed no difference in the response of active intra-articular inflammation in patients who discontinued MTX vs. those who continued TCZ + MTX within the period of observation, consistent with the result of similar mean change in DAS28 between the groups in the primary analysis,” the authors wrote in their abstract.

The results were presented at the 2017 American College of Rheumatology/Association of Rheumatology Health Professionals

Annual Meeting.

The investigators enrolled patients with rheumatoid arthritis who demonstrated an inadequate response to methotrexate. For the initial combination, patients were prescribed ≥15 mg of oral MTX and 162 mg of subcutaneous TCZ either weekly or biweekly.

At week 24, the researchers randomized 296 patients who achieved DAS28-ESR ≤ 3.2 in a 1:1 ratio to receive TCZ monotherapy or TCZ+MTX until week 52. The researchers enrolled 79 of these patients in an MRI substudy, in which they obtained images of bilateral hands and wrists at weeks 24 and 40. They chose MRI because it can image synovitis and osteitis and is more sensitive to bone erosion compared with radiography. The outcomes for the substudy were changes in MRI scores from week 24 and 40 and the percentage of patients with score progression.

There were no significant mean changes from week 24 and 40 between the TCZ+MTX and TCZ-MONO groups in terms of bone erosion score, synovitis score, osteitis score and cartilage loss scores. When the investigators compared progression of each outcome measure, they found no significant differences between the groups (range 89.7% to 97.4% with TCZ+MTX and 87.9% to 100% with TCZ-MONO).