PMID- 27658491
OWN - NLM
STAT- Publisher
LR  - 20220409
IS  - 1478-6362 (Electronic)
IS  - 1478-6354 (Print)
IS  - 1478-6354 (Linking)
VI  - 18
IP  - 1
DP  - 2016 Sep 22
TI  - Tocilizumab as monotherapy or combination therapy for treating active rheumatoid 
      arthritis: a meta-analysis of efficacy and safety reported in randomized 
      controlled trials.
PG  - 211
LID - 211
AB  - BACKGROUND: Previous studies in patients with rheumatoid arthritis (RA) have 
      shown that switching to tocilizumab (TCZ) monotherapy (TCZ(MONO)) or combination 
      therapy (TCZ(COMBI)) with conventional synthetic disease-modifying anti-rheumatic 
      drugs (csDMARDs) is efficacious in reducing disease activity in patients with 
      inadequate response to csDMARDs. However, hitherto there is no consensus on 
      whether TCZ(MONO) is as effective as TCZ(COMBI). The objective of this study was 
      therefore to evaluate the efficacy and safety of TCZ(MONO) versus add-on 
      TCZ(COMBI) and both TCZ therapies versus continuing the current csDMARD therapy, 
      by performing a systematic review and meta-analyses. METHOD: The MEDLINE, EMBASE 
      and CENTRAL databases were searched until February 2016 for relevant randomized 
      controlled trials (RCTs). We performed meta-analyses of Disease Activity Score in 
      28 joints (DAS28 < 2.6), American College of Rheumatology (ACR) 20/50/70 
      responses, adverse events (AEs) and serious AEs (SAEs) to compare the three 
      different strategies, whereas a random-effect model was used for pooling relative 
      risks (RR) and 95 % confidence intervals (CI). In addition, sensitivity analyses 
      were performed for evaluating differences in study duration. RESULTS: In total, 
      13 RCTs were included in the meta-analysis, involving 6679 patients. When 
      comparing both TCZ strategies, a marginally greater proportion of patients 
      achieving DAS28 < 2.6 (RR 1.21; 95 % CI 1.09, 1.36) and ACR50 response (RR 1.14; 
      95 % CI 1.03, 1.26) was found in favor of the TCZ(COMBI) strategy. However, the 
      risk of SAEs was also significantly higher using this strategy (RR 1.40; 95 % CI 
      1.03, 1.92, p = 0.03). Pooled effect estimates showed statistical superiority of 
      switching to either TCZ strategy compared to continuing csDMARD therapy. 
      CONCLUSIONS: In the management of active RA, almost similar efficacy can be 
      expected in patients unable to tolerate csDMARDs, who switch to TCZ(MONO) 
      compared to inadequate responders switching to add-on TCZ(COMBI). Although 
      TCZ(COMBI) is marginally superior to TCZ(MONO) in achieving DAS28 < 2.6 and ACR50 
      response, this is at the cost of an increased risk of SAEs.
FAU - Teitsma, Xavier M
AU  - Teitsma XM
AD  - Department of Rheumatology and Clinical Immunology, University Medical Center 
      Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands. 
      x.m.teitsma@umcutrecht.nl.
FAU - Marijnissen, Anne Karien A
AU  - Marijnissen AK
AD  - Department of Rheumatology and Clinical Immunology, University Medical Center 
      Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands.
FAU - Bijlsma, Johannes W J
AU  - Bijlsma JW
AD  - Department of Rheumatology and Clinical Immunology, University Medical Center 
      Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands.
FAU - Lafeber, Floris P J
AU  - Lafeber FP
AD  - Department of Rheumatology and Clinical Immunology, University Medical Center 
      Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands.
FAU - Jacobs, Johannes W G
AU  - Jacobs JW
AD  - Department of Rheumatology and Clinical Immunology, University Medical Center 
      Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20160922
PL  - England
TA  - Arthritis Res Ther
JT  - Arthritis research & therapy
JID - 101154438
PMC - PMC5034420
OTO - NOTNLM
OT  - Biological
OT  - Disease-modifying anti-rheumatic drugs
OT  - Interleukin-6
OT  - Rheumatoid arthritis
OT  - Tocilizumab
EDAT- 2016/09/24 06:00
MHDA- 2016/09/24 06:00
PMCR- 2016/09/22
CRDT- 2016/09/24 06:00
PHST- 2016/05/10 00:00 [received]
PHST- 2016/09/02 00:00 [accepted]
PHST- 2016/09/24 06:00 [entrez]
PHST- 2016/09/24 06:00 [pubmed]
PHST- 2016/09/24 06:00 [medline]
PHST- 2016/09/22 00:00 [pmc-release]
AID - 10.1186/s13075-016-1108-9 [pii]
AID - 1108 [pii]
AID - 10.1186/s13075-016-1108-9 [doi]
PST - epublish
SO  - Arthritis Res Ther. 2016 Sep 22;18(1):211. doi: 10.1186/s13075-016-1108-9.