1239 - Impact of Tocilizumab Therapy After Switching From Tumor Necrosis Factor (TNF) inhibitors – Prevention of Joint Damage by Tocilizumab in Patients with Inadequate Response to Anti-TNF Therapies –

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Yoshiya Tanaka1, Tsutomu Takeuchi2, Koichi Amano3, Eri Sato4, Masao Nawata5, Hayato Nagasawa6, Daisuke Hoshi7, Kazuyoshi Saito8, Shunsuke Fukuyo5, Kentaro Hanami8, Hideto Kameda2, Takahiko Kurasawa6, Yuko Kaneko9 and Hisashi Yamanaka4, 1University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan, 2Keio University School of Medicine, Tokyo, Japan, 3Saitama Medical Center, Saitama Medical University, Saitama, Japan, 4Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan, 5University of Occupational and Environmental Health, Japan, Kitakyushu, Japan, 6Saitama Medical Ctr, Kawagoe, Japan, 7Tokyo Women's Medical University, Tokyo, Japan, 8University of Occupational & Environmental Health, Japan, Kitakyushu, Japan, 9Keio Univ School of Medicine, Shinjuku-ku, Japan
Presentation Number: 1239

Background/Purpose: Anti-TNF agents are highly effective, but clinical remission is achieved in only about 40% of patients. In this study, we evaluated the efficacy of tocilizumab (TCZ) for preventing the joint damage as well as clinical and functional improvement in patients with inadequate response to anti-TNF agents by comparing the efficacy achieved during anti-TNF therapy one year prior to TCZ treatment.

Method: Baseline characterisitics, efficacy as measured by disease activity score using the 28 joint count (DAS)28-ESR, clinical disease activity index (CDAI), health assessment questionnaire-disability index (HAQ-DI), and modified total Sharp score (mTSS) were assessed.

Result: In total, 145 patients with inadequate response to the anti-TNF therapies were analyzed. At baseline, mean age was 56.6±14.6 years (median [min-max]: 61.0 [15-88]), mean duration of disease was 12.4±10.5 years (median [min-max]: 10.0 [0.1-56.2]), methotrexate (MTX) was concomitantly used in 64.1%. The mean DAS28-ESR, CDAI and HAQ score was improved from 5.71±1.25 at baseline to 2.84±1.53 (% of <2.6=48.5) at week 52, from 26.7±13.1 to, 9.84±9.12 (% of ≤2.8=22.4), and 1.54±0.74 to 1.19±0.81 (% of ≤0.5=26.9), respectively..Analysis of 95 patients with available mTSS revealed the estimated yearly progression (ΔTSS) at baseline to be 16.7, but this had improved to 1.1 at 52 weeks, indicating 93.4% inhibition of joint destruction. Structural remission (ΔTSS≤0.5) was achieved in 53 patients (55.8%). The incidence of the patients who reached DAS28-ESR<2.6, CDAI≤2.8, and ΔTSS≤0.5 were improved significantly after switching from anti-TNF agents to tocilizumab (Table). Especially, Estimated ΔTSS after TCZ treatment (1.37) was significant improved from the EYP during one year anti-TNF treatment.
-52w 0w 52w
Mean DAS28-ESR (% of <2.6) 5.24 (0%) 5.85 (0%) 2.87 (50%)
Mean CDAI (% of ≤2.8) 21.1 (0%) 27.4 (0%) 11.1 (18.9%)
Mean HAQ (% of ≤0.5) 1.24 (16.2%) 1.46 (7.9%) 1.12 (15.8%)
ΔTSS  (% of ≤0.5) 3.55 (42.1%) 1.37 (63.2%)

Conclusion: The clinical response and the efficacy in prevention of joint damage were significantly improved compared to pretreatment by switchin to tocilizumab from TNF-inhibitors in RA patients with inadequate response to TNF-inhibitors.


Keywords: interleukins (IL), joint destruction, rheumatoid arthritis (RA), tocilizumab and tumor necrosis factor (TNF)

Disclosure: Y. Tanaka, Abbott, Astellas Pharma, Chugai Pharma, Mitsubishi-Tanabe Pharma, MSD, Pfizer, Takeda Pharma, 2, Abbott, Astellas Pharma, Chugai Pharma, Eisai Pharma, Mitsubishi-Tanabe Pharma, 8 ; T. Takeuchi, Abbott, Bristol-Myers Squibb, Chugai Pharma, Eisai Pharma, Mitsubishi-Tanabe Pharma, Takeda Pharma, Janssen Pharma, Pfizer, 2 ; K. Amano, Abbott, Astellas Pharma, Chugai Pharma, Eisai Pharma, Mitsubishi-Tanabe Pharma, 2 ; E. Sato, None; M. Nawata, None; H. Nagasawa, None; D. Hoshi, None; K. Saito, None; S. Fukuyo, None; K. Hanami, None; H. Kameda, Mitsubishi-Tanabe Pharma, Centocor, Pfizer, Takeda Pharma, Abbott, Eisai Pharma, Chugai Pharma, 2 ; T. Kurasawa, None; Y. Kaneko, None; H. Yamanaka, Abbott, Bristol-Myers Squibb, Chugai Pharma, Eisai Pharma, Hoffmann-La Roche, Mitsubishi-Tanabe Pharma, Takeda Pharma, Pfizer, 2 .