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Posted by on Jan 27, 2021 in Rheumatoid Arthritis | 0 comments

In a nutshell

This study compared the effectiveness of tocilizumab (Actemra) alone (monotherapy) to combination therapy with tocilizumab and methotrexate (Trexall) in patients with rheumatoid arthritis (RA).

The study concluded that combination treatment with tocilizumab and methotrexate may be more effective in slowing down signs of disease progression in joints.

Some background

RA is caused by inflammation processes. Most often, joints all over the body are affected by this inflammation. It attacks the joints’ structure, which leads to pain, swelling, and ultimately to limited physical function and restricted quality of life. The joint damage may lead to joint space narrowing (JSN). Some areas may even show a loss of bone material (erosion). The proper treatment may help slow down the progression of joint damage and decrease the related symptoms. It is recommended to ensure that the prescribed treatment is effective in slowing down the progression. 

The progression of RA can be monitored by the observation of digital images like X-Ray and MRI (radiographic progression). The images will be assessed, and a score will be calculated that indicates the current state of joint damage caused by inflammation. The higher the score, the more severe the damage. 

Another common measure of disease condition is the DAS28 (disease activity score). It assesses 28 different joints and how severely their function is limited. The higher the DAS28 score (0 – 10), the more severe the limitation of joint function. 

Methotrexate is one of the most common drugs used to treat RA and achieve a slower disease progression. It is known that heavy side-effects and drug-resistance may limit suitability for patients. Tocilizumab is known to effectively slow down disease progression with possibly fewer side-effects. If tocilizumab as monotherapy is more effective than as combination therapy with methotrexate in terms of preventing radiographic progression remains under investigation. 

Methods & findings

The authors observed data from five different studies. Overall, 1506 patients were included. Patients received either tocilizumab alone (T group) or a combination of tocilizumab plus methotrexate (TM group). The patients previously responded insufficiently or not at all to methotrexate as the only treatment. All of the studies used SvdH to measure radiographic progression.

Digital images were taken to monitor the radiographic progression. Each digital image was observed by several medical professionals independently. They determined a score as a measure for radiographic progression. A score of less than zero after two years was considered successful prevention of progression. 

In both patients with early RA and established RA, T alone was 4% less effective to prevent a radiographic progression compared to MT therapy. However, in patients who had a low DAS28 score or more heavy joint damage in the beginning, there was no advantage in MT combination therapy compared to T alone. 

The bottom line

The authors concluded that combination therapy with tocilizumab and methotrexate may be more effective in preventing radiographic progression in patients with RA and limited joint damage.

The fine print

The definitions and criteria might have varied between studies. Additional impacting factors might not have been documented.

What’s next?

Ask your doctor about the advantages, disadvantages, and suitability of either drug for your treatment.

Published By :

Arthritis Care & Research

Date :

Nov 30, 2020

Original Title :

Is tocilizumab monotherapy as effective in preventing radiographic progression in rheumatoid arthritis as its combination with methotrexate?

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