1214 - Early Aggressive Intervention for Rheumatoid Arthritis Increases Rate of Remission Defined Using a Boolean Approach in Clinical Practice with Tocilizumab

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Toshihisa Kojima1, Atsushi Kaneko2, Yuji Hirano3, Hisato Ishikawa4, Yuichiro Yabe5, Hideki Takagi6, Masatoshi Hayashi1, Koji Funahashi1, Daizo Kato1, Hiroyuki Matsubara7, Naoki Ishiguro8 and TBCR Study Group7, 1Nagoya Univeristy, School of Medicine, Nagoya, Japan, 2Nagoya Medical Center, Nagoya, Japan, 3Toyohashi Municipal Hospital, Toyohashi, Japan, 4Nagano Red Cross Hospital, Nagano, Japan, 5Tokyo Kosei Hospital, Tokyo, Japan, 6Nagoya Kyoritsu Hospital, Nagoya, Japan, 7Nagoya, Japan, 8Nagoya University, Graduate School & Faculty of Medicine, Nagoya, Aichi, Japan
Presentation Number: 1214

Background/Purpose: The goal of treating rheumatoid arthritis(RA) should be remission, for which a new definition was proposed in 2011. The efficacy of Tocilizumab for RA, a humanized monoclonal antibody that binds to and inhibits the interleukin-6 (IL-6) receptor, was demonstrated in several clinical trials, and its effectiveness in clinical practice is currently under investigation. To determine which patients can achieve the new Boolean-based definition of remission in clinical practice, we analysed factors associated with remission in 123 patients who received tocilizumab for 52 weeks.

Method: All RA patients (n=134) who underwent tocilizumab treatment between May 2008 and September 2009 at Nagoya University Hospital and 12 other institutes (Tsurumai Biologics Communication Study Group) were enrolled in this study. Demographic data at the initiation of treatment (baseline) and the following parameters of disease activity (tender joint count (TJC) on 28 joints, swollen joint count (SJC) on 28 joints, patient global assessment of disease activity, erythrocyte sedimentation rate (ESR), and serum CRP levels) at baseline and 52 weeks later.  We evaluated remission at 52 weeks using the 2011 definition of remission developed for use in RA clinical trials (Boolean approach). We analysed differences of baseline characteristics with disease duration and factors to determine those associated with remission using logistic regression analysis.

Result: Mean (SD) of age, disease duration and DAS28-ESR were 57 (13) years old, 10.5 (8.5) years and 5.8 (1.4). 52 % of the patients had history of previous TNF-failure.

 We found that patients with short disease duration (<4.8 years) had a significantly higher rate of remission (31.7%) than those with longer disease duration, and patient global assessment was the most important factor for achieving remission (Fig.1). Multivariate analysis revealed the following predictors of remission: short disease duration (<4.8 years; odds ratio [OR] 2.5, 95% confidence interval [CI] 1.4–4.7) and lower disease activity (DAS28-ESR<5.23; OR 2.5, 95% CI 1.2–5.1).

Conclusion: In this study, we showed that remission, as newly defined using a Boolean approach, is a realistic goal for patients with short disease duration in real-world clinical practice with tocilizumab.


Keywords: remission, rhuematoid arthritis, treatment and tocilizumab

Disclosure: T. Kojima, Abbott Japan, Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Mitsubishi Tanabe Pharma, Pfizer Japan Inc., and Takeda Pharmaceutical Co. Ltd., 8 ; A. Kaneko, Abbott Japan, Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Mitsubishi Tanabe Pharma, Pfizer Japan Inc., and Takeda Pharmaceutical Co. Ltd., 8 ; Y. Hirano, None; H. Ishikawa, None; Y. Yabe, None; H. Takagi, None; M. Hayashi, None; K. Funahashi, None; D. Kato, None; H. Matsubara, None; N. Ishiguro, Abbott Japan, Chugai Pharmaceutical Co. Ltd., Daiichi-Sankyo Pharmaceutical Co. Ltd., Eisai Co. Ltd., Mitsubishi Tanabe Pharma, Pfizer Japan Inc., and Takeda Pharmaceutical Co. Ltd., 8, Abbott Japan, Chugai Pharmaceutical Co. Ltd., Daiichi-Sankyo Pharmaceutical Co. Ltd., Eisai Co. Ltd., Mitsubishi Tanabe Pharma, Pfizer Japan Inc., and Takeda Pharmaceutical Co. Ltd., 2 .