Talk: Greater Physical Dysfunction Is a Negative Predictor for Achieving Boolean-Based Remission in Patients with Rheumatoid Arthritis Treated with Tocilizumab (2011 ACR/ARHP Annual Scientific Meeting)

Monday, November 7, 2011: 9:00 AM-6:00 PM

Hall F2 - Poster Hall (McCormick Place West)

Daisuke Hoshi, Kumi Shidara, Yohei Seto, Eiichi Tanaka, Ayako Nakajima, Shigeki Momohara, Atsuo Taniguchi and Hisashi Yamanaka, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan

Presentation Number: 1235

Background/Purpose: A new, Boolean-based definition of remission in the treatment of rheumatoid arthritis (RA) was proposed by the ACR/EULAR in 2010. Tocilizumab (TCZ) directly influences the function of IL-6 resulting in suppression of serum inflammatory markers, so it is necessary to evaluate the efficacy of TCZ by using the new remission criteria.

Methods: We analyzed the efficacy of TCZ treatment in 80 RA patients at 24 weeks after initial treatment with TCZ by using “DAS28 remission” defined to be DAS28-ESR < 2.6 and “Boolean remission” defined to be all criteria in the Boolean definition ≤ 1. We stratified the 80 RA patients by previous use of biologics, by concomitant use of methotrexate (MTX), by age over or under 65 years, by disease duration and by physical dysfunction as measured by the Japanese version of the Health Assessment Questionnaire (J-HAQ). We compared the achievement of “DAS28 remission” by chi-square test and “Boolean remission” by Fisher’s exact test. We further analyzed the predictive factors that influenced the achievement of “Boolean remission” at 24 weeks after initial treatment of TCZ by using stepwise multiple logistic regression analysis.

Results: Among the 80 RA patients, 88.8% were women. The median [25%, 75%] age was 60.0 [48.2, 65.0] years and disease duration was 100 [49, 176] months. MTX was used in 70% of patients and corticosteroid was in 77.5%. The number (percentage) achieving “DAS28 remission” and “Boolean remission” at week 24 were 40 (50.0%) and 10 (12.5%), respectively. There was no difference in reaching remission either defined by “DAS28 remission” or “Boolean remission” when patients were stratified by previous biologics use, concomitant MTX use, or age over or under 65 years. There were significant differences in achieving “Boolean remission”, but not “DAS28 remission”, when patients were stratified by disease duration (p = 0.0368) or by J-HAQ (p = 0.0444) in tertile. The predictive factor for not achieving “Boolean remission” at 24 weeks was a worse baseline J-HAQ score (odds ratio: 3.66, 95% confidence interval: 1.17–14.48).

Table. Risk factors at baseline for not satisfying “Boolean remission” at 24 weeks

	odds ratio	95% confidence interval	P value
Disease duration (month)	1.007	0.099–1.021	0.235
J-HAQ	3.655	1.174–14.475	0.039
ESR (mm/h)	0.98	0.954–1.005	0.121
Corticosteroid use (%)	2.952	0.617–14.085	0.163

Conclusions: This study showed that the achievement of “Boolean remission” was 12.5% and “DAS28 remission” was 50% in patients treated with TCZ. Greater physical dysfunction is a negative predictor for achieving “Boolean remission”.

Keywords: remission, rheumatoid arthritis (RA) and tocilizumab

Disclosure: D. Hoshi, None; K. Shidara, None; Y. Seto, None; E. Tanaka, None; A. Nakajima, None; S. Momohara, None; A. Taniguchi, None; H. Yamanaka, Chugai Pharmaceutical Co.,Ltd., Astellas Pharma Inc., Wyeth K.K., Daiichi Sankyo Co.,Ltd., Banyu Pharmaceutical Co.,Ltd., Mitsubishi Tanabe Pharma Corporation, Abbott Japan Co.,Ltd., Eisai Co.,Ltd., Santen Pharmaceutical Co.,Ltd., Taishotoyama Pharmaceuti, 2, Abbott, Eisai Co.,Ltd., Takeda Pharmaceutical Company Limited, Mitsubishi Tanabe Pharma Corporation, Janssen Pharmaceutical K.K., Hoffmann-La Roche, Chugai Pharmaceutical Co.,Ltd, Pfeizer Inc., 5 .

1235 - Greater Physical Dysfunction Is a Negative Predictor for Achieving Boolean-Based Remission in Patients with Rheumatoid Arthritis Treated with Tocilizumab