1236 - Direct Comparison of Four Biologics in Biologic-na´ve Rheumatoid Arthritis Patients

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Yukio Yonemoto1, Kimihiko Takeuchi2, Koichi Okamura1, Masatoshi Matsushita2, Tsutomu Kobayashi1, Tetsuo Aramaki2, Tetsuya Kaneko1 and Kenji Takagishi1, 1Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan, 2Isesaki Fukushima Hospital, Isesaki, Gunma, Japan
Presentation Number: 1236

Background/Purpose: The treatment of rheumatoid arthritis (RA) has been transformed in recent years by the appearance of novel agents centered on biologics. The idea of “treat to target” has emerged, and the significance of remission has increased dramatically. However, few papers have compared different biologics under the same conditions at the same time, and no consistent view has emerged regarding the choice of agent. We compared treatment response to four biologics, infliximab (IFX), etanercept (ETN), tocilizumab (TCZ) and adalimumab (ADA), in biologic-naïve RA patients who had been started on treatment in the same period in the real clinical setting.

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.

Keywords: adalimumab, etanercept, infliximab, rheumatoid arthritis, treatment and tocilizumab

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.