Predictive factors for induction of remission in patients with active rheumatoid arthritis treated with tocilizumab in clinical practice
Por:
Narvaez, J, Magallares, B, Torne, C, Hernandez, MV, Reina, D, Corominas, H, Sanmarti, R, Llobet, JM, de la Serna, AR, Nolla, JM
Publicada:
1 feb 2016
Resumen:
Objective: To identify predictors of early response to tocilizumab (TCZ) in patients with active rheumatoid arthritis (RA) seen in daily routine clinical practice.
Methods: A multicenter ambispective observational study of 126 RA patients treated with TCZ as a first or second-line biological therapy. The variables associated to achieve the therapeutic goal (remission defined as a DAS28-ESR < 2.6) at 3 and 6 months were identified using regression analysis.
Results: TCZ was administered as the first biologic in 26% of patients. Overall, 34% of patients received TCZ as monotherapy. EULAR response and remission were obtained in 82% and 31% of patients at 3 months and in 86% and 40% at 6 months.
In the multivariate analysis, the predictive factors increasing the likelihood of clinical remission at 3 months were baseline ESR > 30 mm/h (OR = 19.07, 95% CI: 2.720-133.716), baseline CRP > 10 mg/L (OR = 4.95; 95% CI: 1.464-13.826), and the presence of extra-articular manifestations of the disease (OR = 15.45, 95% CI: 2.334-102.319). The factors that decreased it were higher concentrations of hemoglobin (OR = 0.53, 95% CI: 0.319-0.910), higher baseline DAS28-ESR (OR = 0.30, 95% CI: 0.145-0.635) and the number of previous DMARDs (OR = 0.41, 95% CI: 0.221-0.779), and biological therapies used (OR = 0.33, 95% CI: 0.155-0.734).
The only factor that remained statistically significant at 6 months was higher baseline DAS28-ESR (OR = 0.55, 95% CI: 0.347-0.877). No relationship was found with the neutrophil count or with the RF or ACPA positivity.
Conclusion: In routine clinical practice, strong acute phase response, the presence of extra-articular manifestations, and the number of previous DMARDs and biological therapies used may help to identify patients who will have a rapid response to TCZ. However, it is likely that no parameter will predict response if taken separately. (C) 2015 Elsevier Inc. All rights reserved.
Filiaciones:
Narvaez, J:
Hosp Univ Bellvitge IDIBELL, Dept Rheumatol Planta 10 2, Feixa Llarga S-N, Barcelona 08907, Spain
Magallares, B:
Hosp Santa Cruz & St Pau, Rheumatol Unit, Barcelona, Spain
Torne, C:
Hosp Santa Cruz & St 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
Sanmarti, R:
Hosp Clin Barcelona IDIBAPS, Dept Rheumatol, Barcelona, Spain
Llobet, JM:
Hosp Santa Cruz & St Pau, Rheumatol Unit, Barcelona, Spain
de la Serna, AR:
Hosp Santa Cruz & St Pau, Rheumatol Unit, Barcelona, Spain
Nolla, JM:
Hosp Univ Bellvitge IDIBELL, Dept Rheumatol Planta 10 2, Feixa Llarga S-N, Barcelona 08907, Spain
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