medwireNews: Escalating tocilizumab treatment from every 2 weeks to weekly could benefit patients with rheumatoid arthritis (RA) who fail to achieve low disease activity (LDA) within 12 weeks, suggests research.
Nora Singer (Case Western Reserve University, Cleveland, Ohio, USA) and colleagues studied the effects of escalating treatment with the interleukin-6 receptor inhibitor tocilizumab from every 2 weeks during the first 12 weeks to weekly for a further 12 weeks among 328 patients with RA in the COMP-ACT trial.
This was then compared with the effects of maintaining a constant dose among 285 RA patients in the SUMMACTA trial, who received weekly treatment for 24 weeks, and 196 patients in the BREVACTA trial who received treatment every 2 weeks for 24 weeks.
As reported in a poster presentation at the ACR Convergence 2020 virtual meeting, the patients weighed less than 100 kg and received subcutaneous tocilizumab 162 mg plus methotrexate in COMP-ACT, and the same dose of tocilizumab in addition to conventional synthetic DMARDs in SUMMACTA and BREVACTA. All of the patients had failed to achieve a DAS28-ESR score below 3.2 points after 12 weeks.
The researchers found that patients in the COMP-ACT trial had significantly better disease activity on all outcomes at week 24 than the 71 North American patients in the SUMMACTA trial, who were most closely matched in terms of demographics and clinical characteristics.
Specifically, 37.2% of COMP-ACT patients achieved DAS28-ESR LDA (2.6 to 3.2 points), 20.1% achieved DAS28-ESR remission (<2.6 points), 24.4% achieved CDAI LDA (>2.8 to 10.0 points), 3.7% achieved CDAI remission (≤2.8 points), 27.1% achieved SDAI LDA (>3.3 to 11.0 points), and 4.9% achieved SDAI remission (≤3.3 points).
This compared with corresponding rates of 23.9%, 9.9%, 15.5%, 2.8%, 15.5%, and 2.8% for North American SUMMACTA participants.
Further to this, secondary analysis showed similar results for DAS28-ESR LDA and remission when COMP-ACT participants were compared with patients from BREVACTA, and all patients from the SUMMACTA trial, irrespective of their geographical region, while CDAI and SDAI outcomes were comparable between COMP-ACT patients and all SUMMACTA trial patients.
“These results provide evidence that escalation from [every 2 weeks] to [weekly] has more effect than would be expected without dose change for patients who do not achieve LDA by week 12,” Singer reported.
“Optimizing [tocilizumab] dosing to achieve treatment targets provides patients with more therapy options and allows healthcare providers to adjust treatment in response to the clinical needs of their patients.”
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