Tocilizumab discontinuation after attaining remission in patients with rheumatoid arthritis who were treated with tocilizumab alone or in combination with methotrexate: results from a prospective randomised controlled study (the second year of the SURPRISE study)

Abstract

ObjectiveTo evaluate the sustained remission and low disease activity after discontinuation of tocilizumab in patients with rheumatoid arthritis who were treated with tocilizumab alone or in combination with methotrexate.MethodsThe SURPRISE study was a 2-year, open-label randomised controlled study. Among patients who had been randomised to additional tocilizumab (ADD-ON) or switch to tocilizumab (SWITCH) in the first year, those who achieved remission based on the disease activity score for 28 joints (DAS28-ESR<2.6) discontinued tocilizumab at week 52 and were observed for the following 52 weeks. The endpoint of the second year included tocilizumab-free remission and low disease-activity rates, functional outcome, radiological outcomes assessed with the modified total Sharp score (mTSS) and safety. The efficacy of reinstituted tocilizumab/methotrexate was also evaluated.ResultsA total of 105 patients who achieved remission at week 52 discontinued tocilizumab; 51 in ADD-ON continued methotrexate and 54 in SWITCH received no disease-modifying antirheumatic drugs. Sustained DAS28 low disease-activity rates were significantly higher in ADD-ON than in SWITCH (55%vs27%, p=0.005). Sustained remission rates at week 104 were 24% for ADD-ON and 14% for SWITCH (p=0.29). Radiological progression was comparable between both groups (mTSS; 0.37vs0.64, p=0.36). The restart of tocilizumab induced remission in all except two patients after 36 weeks, irrespective of concomitant methotrexate.ConclusionSustained low disease activity after tocilizumab discontinuation could be maintained with continued methotrexate in more than half of the patients. Retreatment with tocilizumab led to remission in more than 90% of patients.Trial registration number NCT01120366; Results.

Exposure‐response modeling of tocilizumab in rheumatoid arthritis using continuous composite measures and their individual components

“…We also observe this trend in our cohort of patients, with expected lower overall remission values due to the fact that our study was performed on an established and refractory population. This difference in remission rates is not exclusive to tocilizumab‐treated patients, suggesting as a possible cause the stringency in the definition of remission criteria. Other authors have shown similar results, where about 60% of the patients in remission according to DAS28 fell into active disease states when assessed with SDAI or CDAI.…”

Coronavirus disease 2019 (COVID-19): a clinical update

“…Tocilizumab is a humanized IgG1k monoclonal antibody which can specifically bind soluble or membrane-type IL-6 receptors (Sil-6R and Mil-6R), and has been widely used in the treatment of autoimmune diseases such as rheumatoid arthritis [58], adult-onset Still's disease [59], and large vessel vasculitis [60]. For COVID-19 infection, clinical studies have shown that serum levels of inflammatory mediators in severe patients are significantly higher than those in common patients [22].…”

Management of rheumatoid arthritis: 2019 updated consensus recommendations from the Hong Kong Society of Rheumatology

“…In the event of sustained remission (> 6 months) during combined csDMARD/bDMARD therapy, bDMARD tapering is feasible in a subset of patients-especially patients with early RA [159,183]. The risk of flare may be lowered if the bDMARD dose is reduced rather than discontinued [164].…”