Comparative Effectiveness of Tocilizumab with either Methotrexate or Leflunomide in the Treatment of Rheumatoid Arthritis
Por:
Narvaez, J, Diaz-Torne, C, Magallares, B, Hernandez, MV, Reina, D, Corominas, H, Sanmart, R, de la Serna, AR, Llobet, JM, Nolla, JM
Publicada:
1 abr 2015
Resumen:
Objective
In agreement with EULAR recommendations, a DMARD in combination with a biotherapy is the reference treatment because of the superior long-term clinical and radiographic outcomes. Methotrexate (MTX) is the cornerstone of combination therapy but is in some cases contra-indicated or poorly tolerated. This observational study aimed to compare the effectiveness and safety of TCZ in combination with either MTX or leflunomide (LEF) in the treatment of patients with active rheumatoid arthritis (RA) and an inadequate response to one or more DMARDs and/or biological agents in a real-world setting.
Methods
We performed an ambispective review of 91 patients with active RA who were routinely treated with TCZ plus MTX or LEF. A comparative study between the two combinations of treatment was performed at 6 months of follow-up considering 3 outcomes: improvement of RA disease activity, evolution of functional disability, and tolerability and side effect profile.
Results
Of the 91 patients, 62 received TCZ with MTX and 29 received TCZ with LEF. Eighty-one patients were followed for 6 months, and the remaining 10 patients discontinued treatment due to serious adverse events. At baseline, there were no significant differences between the groups in terms of the main clinical and laboratory data or in the number of previous DMARDs and biological agents used. At 6 months, there were no significant differences between the combinations in terms of disease activity and functional disability. Serious adverse events occurred in 11% and 10% of the patients treated in combination with MTX and LEF, respectively.
Conclusion
Our preliminary data support the argument that LEF is an effective and safe (equivalent) alternative to MTX for combination treatment with TCZ.
Filiaciones:
Narvaez, J:
Hosp Univ Bellvitge IDIBELL, Dept Rheumatol, Barcelona, Spain
Diaz-Torne, C:
Hosp Santa Creu & Sant Pau, Rheumatol Unit, Barcelona, Spain
Magallares, B:
Hosp Santa Creu & Sant Pau, Rheumatol Unit, Barcelona, Spain
Hernandez, MV:
Hosp Clin Barcelona, IDIBAPS, Dept Rheumatol, Barcelona, Spain
Reina, D:
Hosp St Joan Despi, Dept Rheumatol, Consorci Sanitari Integral, Barcelona, Spain
Corominas, H:
Hosp St Joan Despi, Dept Rheumatol, Consorci Sanitari Integral, Barcelona, Spain
Sanmart, R:
Hosp Clin Barcelona, IDIBAPS, Dept Rheumatol, Barcelona, Spain
de la Serna, AR:
Hosp Santa Creu & Sant Pau, Rheumatol Unit, Barcelona, Spain
Llobet, JM:
Hosp Santa Creu & Sant Pau, Rheumatol Unit, Barcelona, Spain
Nolla, JM:
Hosp Univ Bellvitge IDIBELL, Dept Rheumatol, Barcelona, Spain
Green Published, gold, Green Submitted
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