Comparison of subcutaneous tocilizumab with intravenous tocilizumab in rheumatoid arthritis

The authors compared the safety and long-term effectiveness of subcutaneous (injected under skin) tocilizumab (Actemra) to intravenous (injected through veins) tocilizumab in patients with rheumatoid arthritis (RA). 

The authors aimed to compare the safety and effectiveness of SC tocilizumab compared to IV tocilizumab over a 97-week period.

1,262 patients participated in this study. For the first 24 weeks, patients were randomly assigned to receive either SC tocilizumab or IV tocilizumab, both in combination with other RA drugs. After 24 weeks, patients receiving SC tocilizumab were randomly reassigned to receive SC or IV tocilizumab for the next 72 weeks. Similarly, patients receiving IV tocilizumab were randomly reassigned to receive SC or IV tocilizumab for 72 weeks. There was a 1 week interval between treatment reassignment.

Patient outcomes were assessed using the American College of Rheumatology (ACR) guidelines and the disability index. ACR guidelines measured 20%, 50% or 70% improvements in swollen or tender joints after treatment. The disability index measured patient activity using a scoring system from 0 to 3. A score of 0 indicated ‘no difficulty’ and a score of 3 indicated ‘cannot be done at all’. Both the SC and IV tocilizumab groups showed similar improvements after treatment. 75.5% of SC patients experienced an ACR response by week 24. This was compared to 78.2% in the IV patient group. 83.6% of SC patients experienced an ACR response by week 97. This was compared to 83.3% in the IV patient group. This response rate was maintained when treatments were randomly switched.

The safety profiles for both SC and IV tocilizumab were similar. The most common side effect reported was infection. 63.2% of the SC group experienced infection, compared to 57.8% in the IV group. Patients who switched from SC to IV treatment had an infection rate of 56.3%. A common side effect in the SC tocilizumab group was an allergic reaction at the site of injection. Treatment safety was similar in patients who only received SC or IV tocilizumab, as well as in patients who switched treatments.

The authors concluded that treatment of RA with SC tocilizumab_­ was well tolerated and showed long-term effectiveness which was comparable to that of IV tocilizumab_­.