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Rheumatology (Oxford). 2015 Jan;54(1):113-20. doi: 10.1093/rheumatology/keu302. Epub 2014 Aug 7.

Importance of methotrexate therapy concomitant with tocilizumab treatment in achieving better clinical outcomes for rheumatoid arthritis patients with high disease activity: an observational cohort study.

Author information

1
Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan. toshik@med.nagoya-u.ac.jp.
2
Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.
3
Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan. Department of Orthopaedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya, Department of Rheumatology, JCHO Tokyo Shinjyuku Medical Center, Tokyo, Department of Orthopaedic Surgery, Nagoya Medical Centre, Nagoya, Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Department of Orthopaedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya and Department of Orthopaedic Surgery, Nagoya University, Faculty and Graduate School of Medicine, Nagoya, Japan.

Abstract

OBJECTIVE:

The purpose of this study was to identify the effects of concomitant use of MTX and baseline characteristics for remission in the treatment of RA with tocilizumab (TCZ) in daily clinical practice.

METHODS:

A total of 240 RA patients who received TCZ were selected from the multicentre Tsurumai Biologics Communication Registry. Predictive baseline factors for remission [28-item DAS (DAS28) < 2.6] at 52 weeks were determined by logistic regression analysis. To confirm whether the associations varied by the level of baseline disease activity, we also assessed the model including the interaction term (each baseline variable × DAS28).

RESULTS:

In total, 49.3% of the study participants used MTX with TCZ. Even after controlling for the baseline DAS28, shorter disease duration (≤3 year) [odds ratio (OR) 3.58 (95% CI 1.81, 7.07)], less structural damage [Steinbroker stage ≤II, OR 2.33 (95% CI 1.32, 4.12)] and concomitant prednisolone use [OR 0.38 (95% CI 0.21, 0.68)] showed significant predictive values for remission. Concomitant MTX use failed to show a significant association with remission, whereas a significant interaction was observed among concomitant MTX use × DAS28 (P = 0.006). In patients with high baseline disease activity (DAS28 > 5.1), concomitant MTX use was associated with increased odds for remission [adjusted OR for all baseline variables 2.54 (95% CI 1.11, 5.83)], while no association was indicated between them in patients with low to moderate baseline disease activity (DAS28 ≤ 5.1).

CONCLUSION:

Concomitant MTX use is an important component of TCZ treatment for RA patients with high disease activity.

KEYWORDS:

biologics; methotrexate; rheumatoid arthritis; tocilizumab

PMID:
25102861
DOI:
10.1093/rheumatology/keu302
[Indexed for MEDLINE]

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