Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Influence of ESR on EULAR Response Rates in Patients Treated with Tocilizumab. Results from the German Biologics Register RABBIT.

Strangfeld1,  Anja, Eveslage1,  Maria, Listing1,  Joachim, Herzer5,  Peter, Liebhaber4,  Anke, Krummel-Lorenz3,  Brigitte, Zink2,  Angela

German Rheumatism Research Center, Berlin, Germany
German Rheumatism Research Center and Charité Berlin, Berlin, Germany
Rheumatologist Frankfurt/M, Frankfurt, Germany
Rheumatologist Halle/S, Halle/Saale, Germany
Scientific Advisory Board, Munich, Munich, Germany


Tocilizumab, a biologic agent newly approved for the treatment of rheumatoid arthritis (RA), is a human anti-interleukin (IL-)-6 receptor antibody. Clinical studies reported high response and remission rates in patients treated with this agent. Blocking the IL-6 receptor directly inhibits the production of acute-phase reactant proteins (including CRP) in hepatocytes. CRP or ESR are important components of the disease activity score (DAS) used to measure the effectiveness of a treatment.

We therefore investigated the contribution of the single components of the DAS28 to treatment response in tocilizumab treated patients in daily rheumatologic care.


The German biologics register RABBIT is a prospective cohort study observing all licensed biologic agents applied in RA patients since 2001. In January 2009, tocilizumab was approved in Germany and patients starting this treatment were enrolled in the register. All patients included in the register will be followed up for at least 5 years with regular assessments including clinical status as well as therapy. Disease activity is measured with the DAS28 using the ESR.


A total of 6,861 patients were enrolled in the register, 243 patients were treated with tocilizumab. Their mean age at start of tocilizumab was 57 years and the median disease duration 10 years.

Of 119 patients with a three months follow-up, 36% achieved a good and additional 29% a moderate EULAR response. 27% of the patients were in remission (DAS28 < 2.6). After 6 months (n = 55) the proportion of patients reaching a good EULAR response was 49%, a moderate response was reached by additional 29%. 40% of the patients were in remission.

Separating the DAS28 into its components, significant changes in swollen and tender joint counts and patient global assessment were observed in patients treated with tocilizumab. Compared to patients receiving other biologics the decrease in ESR levels was significantly higher (figures).


Treatment with tocilizumab improves RA in a substantial proportion of patients, response and remission rates are high. However, when considering EULAR response rates, changes in DAS28 scores or DAS28 remission rates the high impact of ESR changes on these measures has to be taken into account.

Figures. Components of the DAS28 (ESR and swollen joint count) and their change after 3 and 6 months after start of treatment with various biologic agents.

To cite this abstract, please use the following information:
Strangfeld, Anja, Eveslage, Maria, Listing, Joachim, Herzer, Peter, Liebhaber, Anke, Krummel-Lorenz, Brigitte, et al; Influence of ESR on EULAR Response Rates in Patients Treated with Tocilizumab. Results from the German Biologics Register RABBIT. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1112
DOI: 10.1002/art.28879

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