Tocilizumab Offers Greater Likelihood of Improvements in Patients Whose DMARD Therapy Failed

A meta-analysis of clinical trials assessed patient-reported outcomes in participants receiving tocilizumab or anti-tumor necrosis factors.

Tocilizumab therapy offers a greater likelihood of improvements in patient-reported outcomes than anti-tumor necrosis factor therapy in patients with rheumatoid arthritis who were intolerant to, or did not respond, to disease-modifying therapy.

“Both antitumor necrosis factor and tocilizumab as monotherapy demonstrated greater reductions in pain, self-reported disease activity, and functional ability than placebo,” the researchers wrote. “However, improvements with tocilizumab monotherapy were greater than anti-tumor necrosis factor monotherapy in terms of pain and self-reported disease activity.”

According to a meta-analysis of 26 randomized-controlled trials published in the July 3, 2014 edition of Health and Quality of Life Outcomes, tocilizumab therapy showed greater improvements than anti-tumor necrosis factor monotherapy. Both anti-tumor necrosis factor therapy and tocilizumab monotherapy resulted in greater reductions in pain and self-reported disease activity than placebo, however.

Tocilizumab was at least as efficacious as anti-tumor necrosis factor therapy in terms of participants’ functional ability, researchers noted.

The study also analyzed each therapy in combination with methotrexate. Both tocilizumab and antitumor necrosis factors used in combination with methotrexate tended to show comparable reductions in pain and patient-reported disease activity relative to methotrexate alone. Patient reported-outcomes also tended to be similar regardless of whether patients received tocilizumab as monotherapy or as combination therapy.

Further analysis revealed the greatest improvements over methotrexate alone in the patient disability index when receiving either antitumor necrosis factors or tocilizumab combined with methotrexate.

“The clinically meaningful differences in pain, patient’s global assessment of disease activity, and health assessment-questionnaire disability index between monotherapy and combination therapy can have important clinical implications,” the researchers wrote. “In patients unable to tolerate methotrexate, tocilizumab appears to offer a greater likelihood of patient-reported outcome improvements than antitumor necrosis factor monotherapy, and may represent an attractive option in this population.”