Successful long-term remission through tapering tocilizumab infusions: a single-center prospective study

Abstract

Background: Strategic drug therapy for rheumatoid arthritis (RA) patients with prolonged remission is not well defined. According to recent guidelines, tapering biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) may be considered. We aimed to evaluate the effectiveness of long-term maintenance of tocilizumab (TCZ) treatment after the progressive tapering of infusions. Methods: We conducted an exploratory, prospective, single-center, open-label study, on RA patients with sustained remission of at least 3 months and treated with TCZ infusions every 4 weeks. The initial re-treatment interval was extended to 6 weeks for the first 3 months. Thereafter, the spacing between infusions was determined by the clinician. Successful long-term maintenance following the tapering of TCZ infusions was defined by patients still treated after two years by TCZ with a minimum dosing interval of 5 weeks. Results: Thirteen patients were enrolled in the study. Eight out of thirteen were still treated by TCZ after two years. Successful long-term maintenance was possible in six patients, with four patients maintaining a re-treatment interval of 8-weeks or more. We observed 5 patients with TCZ withdrawal: one showing adverse drug reaction (neutropenia) and four with secondary failure. Patients achieving successful long-term maintenance with TCZ were significantly younger than those with secondary failure (p < 0.05). In addition, RA patients with positive rheumatoid factor and anti-citrullinated peptide antibodies, experienced a significantly greater number of flares during our 2year follow-up (p < 0.01). Conclusions: A progressive tapering of TCZ infusions may be possible for many patients. However, larger studies, including more patients, are needed to confirm this therapeutic option.

Towards the Lowest Efficacious Dose: Results From a Multicenter Noninferiority Randomized Open‐Label Controlled Trial Assessing Tocilizumab or Abatacept Injection Spacing in Rheumatoid Arthritis in Remission

“…Indeed, previous studies, such as DREAM or SONATA, were retrospective or had no control group. 24,25,33 Second, our trial proposed a progressive and DAS-driven tapering strategy, whereas the two previous studies used an abrupt discontinuation of TCZ, which could explain why the outcomes in these studies were worse than in our findings. 24 Although guidelines report that tapering of bDMARDs would be a relevant strategy in patients in sustained remission when drug tapering is considered, 12,13 our study suggests no benefit when this strategy is applied to patients receiving TCZ or ABA.…”

“…First, to our knowledge, it is the first RCT aiming to assess the possibility of tapering TCZ or ABA, for which the published data are limited. Indeed, previous studies, such as DREAM or SONATA, were retrospective or had no control group 24,25,33 . Second, our trial proposed a progressive and DAS‐driven tapering strategy, whereas the two previous studies used an abrupt discontinuation of TCZ, which could explain why the outcomes in these studies were worse than in our findings 24 .…”

The Aftermath of Tapering Tocilizumab After Achieving Treatment Target in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study

“…In this context, the results of this study provide important evidence for clinical decisions on tapering TCZ dose in daily practice. A few previous studies suggested that tapering TCZ could be a feasible option, but they were single-center studies and included relatively a small number of patients ( 25 , 26 ). To the best of our knowledge, this study is the largest cohort study that investigated the efficacy of tapering TCZ in a large nationwide cohort, which strengthens the generalizability of the results.…”