Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Impact of Tocilizumab Therapy for Remission Quartet in Rheumatoid Arthritisthe Result of 104 Weeks Follow up Data of REACTION study.

Tanaka1,  Yoshiya, Takeuchi2,  Tsutomu, Amano3,  Koichi, Sato4,  Eri, Nawata5,  Masao, Nagasawa6,  Hayato, Hoshi7,  Daisuke

University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan
Keio University School of Medicine, Tokyo, Japan
Saitama Medical Center, Saitama Medical University, Saitama, Japan
Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
Saitama Medical Ctr, Kawagoe, Japan
Tokyo Women's Medical University, Tokyo, Japan
University of Occupational & Environmental Health, Japan, Kitakyushu, Japan
Keio Univ School of Medicine, Shinjuku-ku, Japan

Background/Purpose:

Biologics have changed dramatically the management of patients with rheumatoid arthritis (RA). Four levels of remission based on the concept of "treating to target" have been required, which is to achieve clinical, structural, and functional remission as well as to sustain remission over the long term. We evaluated those remissions and their sustainment in the REACTION Study, an observational study on tocilizumab (TCZ) in daily clinical practice.

Methods:

The 229 patients were treated with TCZ 8 mg/kg every 4 weeks. The clinical remission (the disease activity score using the 28 joint count (DAS)28-ESR<2.6 and clinical disease activity index (CDAI)<=2.8), structural remission (the estimated yearly progression of modified total Sharp score (DmTSS) <=0.5), and functional remission (health assessment questionnaire (HAQ)<=0.5) were evaluated. Sustained remission was defined as the remission sustainment rate at week 104 in patients who achieved remission at 52 weeks.

Results:

Treatment with TCZ was continued for 2 years in 127 patients (55%). The patient characteristics who continued 2 years TCZ treatment were as follows. Mean age: 57.9 years; mean disease duration: 11.3 years; prior treatment with TNF inhibitor: 80 patients (63.0%); concomitant methotrexate (MTX): 80 patients (63.0%). The remission rates represented by DAS28<2.6 and CDAI<=2.8 (measures of clinical remission) and HAQ<=0.5 (measure of functional remission) tended to increase over time. At Week 104, 71.2% had achieved DAS28<2.6, 37.4% had achieved CDAI<=2.8, and 38.2% had achieved HAQ<=0.5. The main reason for discontinuation of TCZ was adverse drug reactions (47/229, 20.5%). In adverse drug reactions, pneumonia was 9 cases. Analysis of mTSS in 112 patients out of the 127 patients revealed DmTSS to be 20.1 at baseline, 1.1 at Week 52, and 0.6 at Week 104, indicating 97% inhibition compared to baseline. DmTSS<=0.5 was about the same at Weeks 52 and 104, with DmTSS<=0.5 at Week 104 in 52.9% (Table). Sustained remission: DAS28<2.6 in 85.5%, CDAI<=2.8 in 70.0%, DmTSS<=0.5 in 64.9%, and HAQ<=0.5 in 83.3%. Multivariate analysis revealed predictive factors affecting total remission of DAS28, CDAI, TSS and HAQ at week 104 were disease duration (P=0.03) and CDAI (P=0.04) at baseline.

 0w24w52w104w
DAS28-ESR<2.60 (0%)67 (54%)69 (59%)89 (71%)
CDAI<=2.80 (0%)18 (15%)30 (22%)46 (37%)
DTSS<=0.557(56%)54(53%)
HAQ<=0.516 (13%)36 (29%)38 (31%)47 (38%)

Conclusion:

Patients who could continue treatment with tocilizumab for 2 years were achieved significant remission of CDAI, which includes no measures for assessing inflammatory markers such as CRP. Moreover, structural remission and functional remission were both maintained over the long term in a high percentage of patients.

To cite this abstract, please use the following information:
Tanaka, Yoshiya, Takeuchi, Tsutomu, Amano, Koichi, Sato, Eri, Nawata, Masao, Nagasawa, Hayato, et al; Impact of Tocilizumab Therapy for Remission Quartet in Rheumatoid Arthritisthe Result of 104 Weeks Follow up Data of REACTION study. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1237
DOI:

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