Management of rheumatoid arthritis in People's Republic of China – focus on tocilizumab and patient considerations

Abstract

The prevalence of rheumatoid arthritis (RA) is 0.19%–0.41% in Chinese population. RA exerts profound influence on health-related quality of life (HRQoL), which imposed huge burdens on patients physically, mentally, and economically. As a developing country, People’s Republic of China faces enormous challenges in management of RA. Conventional-synthesized disease-modifying antirheumatic drugs (csDMARDs) remain the most selective therapeutic options for RA in People’s Republic of China owing to their affordable price and fair efficacy as well as tolerability. Unfortunately, there are substantial RA patients who are poor responders to csDMARDs, even to subsequently combined therapy with tumor necrosis factor antagonist (anti-TNF). Tocilizumab (TCZ) has been approved as a subsequent-line biological agent in patients with moderate-to-severe RA worldwide including People’s Republic of China. TCZ is the first biological agent approved for the treatment of RA inhibiting interlukin-6 (IL-6) by blocking both membrane-bound and soluble IL-6 receptors. Open-label studies in real-life practice and strictly controlled clinical trials demonstrated its high efficacy and safety profile in treatment of patients with RA who have inadequate responses to csDMARDs and anti-TNF. HRQoL of RA patients was improved in various measurements. TCZ was associated with 1.2 times the risk of adverse events, such as infections, dyslipidemia, and hepatic transaminases elevation, compared with pooled placebo. A relatively long half-life allowing for monthly intravenous administration and a newly developed subcutaneous injection make TCZ more acceptable. However, data are not enough so far comparing TCZ to anti-TNF. Lack of evidence in Chinese patients and high cost of TCZ limit its prescription in People’s Republic of China being a developing country. Further clinical trials and post-marketing surveillance may offer a comprehensive assessment of patient satisfaction and acceptability, which may help us define the optimal role for TCZ in therapeutic strategy.

Interleukin-6 (IL-6) Receptor Antagonist Protects Against Rheumatoid Arthritis

“…This study showed that TCZ significantly improved patient condition by decreasing DAS28 score, CRP, RF, and CCP levels by more than half ( P <0.01). Our results are consistent with previous reports of TCZ remarkably improving RA patients at moderate and severe active stages [ 22 ].…”

Can active components of licorice, glycyrrhizin and glycyrrhetinic acid, lick rheumatoid arthritis?

“…RA exerts profound influence on health-related quality of life, which imposed huge burdens on patients physically, mentally, and economically [ 63 ]. The general effectiveness of typically prescribed medications for patients with RA, including NSAIDs and DMARDs, has been far from satisfactory [ 1 , 64 ].…”

Cost-effectiveness of Anbainuo Plus Methotrexate Compared to Conventional Disease-modifying Antirheumatic Drugs for Rheumatoid Arthritis Patients in China

“…Rheumatoid arthritis (RA) is one of the most common chronic, in ammatory, autoimmune diseases with a prevalence of 0.5%-1% worldwide and 0.19%-0.4% in China [1,2]. Clinically, RA patients not only suffer from swelling and pain in both small joints (e.g., metacarpophalangeal) and large joints (e.g., ankle), but also may be affected by extra-articular manifestations such as rheumatoid vasculitis and interstitial lung disease [3].…”