Method: One hundred and forty-two biologic-naïve RA patients were started on a biologics (IFX 37, ETN 39, TCZ 27, ADA 39) from July 2008 onwards. Baseline and six months later, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), matrix metalloproteinase-3 (MMP-3), the swollen and tender joint counts, the Disease Activity Score in 28 joints using ESR (DAS28-ESR) and the European League Against Rheumatism (EULAR) remission criteria (DAS28-ESR<2.6) were examined. The drug survival rate on each agent was also surveyed.
Result: After 6 months, ESR, CRP, MMP-3, the swollen and tender joint counts and DAS28-ESR had fallen significantly from baseline with all four agents. Comparing the individual products, DAS28-ESR and MMP-3 fell significantly more with TCZ than with IFX and ETN. No significant difference was identified at 6 months in the DAS28-ESR remission rates (DAS28-ESR<2.6) and drug survival rate for each biologics.
Conclusion: In this study, DAS28-ESR was used whereas remission standards including clinical disease activity index (CDAI), simplified disease activity index (SDAI) and Boolean definition have been proposed at present. It has been reported that TCZ, which directly inhibits acute-phase reactant, can lead to an overestimation of the response to treatment. Another paper sets out a correlation between DAS28-ESR and CDAI, SDAI, and states that evaluation based on DAS28 is valid. The present study indicated a larger fall in MMP-3 with TCZ than with the other two agents, and suggested that TCZ may provide therapeutic efficacy at least comparable to TNF inhibitors in biologic-naïve RA patients.
Disclosure: Y. Yonemoto, None; K. Takeuchi, None; K. Okamura, None; M. Matsushita, None; T. Kobayashi, None; T. Aramaki, None; T. Kaneko, None; K. Takagishi, None.