Tocilizumab at EULAR 2012

Concerning Tocilizumab, my most important question to solve at the EULAR 2012 has been: How about subcutaneous tocilizumab? We come to the answer to this question in a moment. There have been other issues, too, like safety or monotherapy. Roche-Chugai is forcing the option of monotherapy. So subcutaneous tocilizumab has to wait for the moment.


A. Ogata and colleagues looked at subcutaneous tocilizumab monotherapy versus intravenous tocilizumab monotherapy in a study called Musashi (after the great samurai / sword fighter). Patients with rheumatoid arthritis, who had responded inadequately, were randomized 162 mg tocilizumab subcutaneously every two weeks intravenous tocilizumab at 8 mg/kg every 4 weeks without any DMARDs. Both efficacy and safety data suggest equality of subcutaneous tocilizumab monotherapy and intravenous tocilizumab monotherapy. When will subcutaneous tocilizumab come to the market? Well informed circles say around March/April 2013, but that’s still a rumour as nobody of Roche-Chugai wanted to comment on the date.

[FRI0180] THE MUSASHI STUDY: COMPARISON OF SUBCUTANEOUS TOCILIZUMAB MONOTHERAPY VERSUS INTRAVENOUS TOCILIZUMAB MONOTHERAPY: RESULTS FROM A DOUBLE-BLIND, PARALLEL-GROUP, COMPARATIVE PHASE III NON-INFERIORITY STUDY IN JAPANESE PATIENTS WITH RHEUMATOID ARTHRITIS
A. Ogata, and MUSASHI Study Group. Department of Allergy and Rheumatic Disease, Osaka University Graduate School of Medicine, Suita, Japan
Conclusions: TCZ-SC was non-inferior to TCZ-IV for ACR20 response rates. Other efficacy variables were also comparable between TCZ-SC and TCZ-IV. Serum trough concentration of TCZ in TCZ-SC was comparable to TCZ-IV. The clinical safety profile of TCZ-SC was consistent with that of TCZ-IV, and TCZ-SC was as well-tolerated as TCZ-IV.

O. Saiki an colleagues looked at the aspect of discontinuing methotrexate and prednisolone. Interestingly, it couldn’t be done with infliximab and etanercept, but tocilizumab sudeeded. In German rheumatology circles we would be careful with ending a maybe needed additional effect.


[AB0565] DISCONTINUANCE OF METHOTREXATE AND PREDNISOLONE IN TREATMENT WITH TOCILIZUMAB BUT NOT WITH INFLIXIMAB OR ETANERCEPT IN RHEUMATOID ARTHRITIS PATIENTS WITH HIGH DISEASE ACTIVITY. (MONOTHERAPY BY TOCILIZUMAB)
O. Saiki, H. Uda. Higashiosaka City General Hospital, Higashiosaka, Japan
Conclusions: These results show the possibility of monotherapy by TCZ but not by IFX or ETA even in RA patients with high activities. Indeed it is suggested that IL-6 and TNF-α have similar effects on inflammation of RA but the different roles exist between IL-6 and TNF-α in RA inflammation.

H. Uda and colleagues looked at myalgia in patients receiving biologics. RA patients treated with tocilizumab more often complained about myalgia


[FRI0186] TOCILIZUMAB BUT NOT INFLIXIMAB THERAPY INDUCES MYALGIA AMONG RHEUMATOID ARTHRITIS PATIENTS WITH HIGH DISEASE ACTIVITY
H. Uda, O. Saiki. Higashiosaka City General Hospital, Higashiosaka, Japan
Conclusions: The RA patients treated with tocilizumab frequently experienced myalgia but did not with infliximab in case of high disease activity. In the patients who complained myalgia, the levels of IL-6 but not CRP or TNF-α were selectively high in spite of decreasing the disease activities. Before tocilizumab treatment, the patients did not complain myalgia, when both IL-6 and CRP levels were high, suggesting the myalgia supposed due to interaction of IL-6 and tocilizumab and not to TNF-α associated interaction.

Another interesting study comes from S. Momohara and colleagues on complications after orthopaedic surgery in rheumatoid arthritis patients. Post surgery CRP levelsmight not reach as high as expected by the surgeons. They must be instructed to look toostoperative conditions and surgical wounds, as well as subjective symptoms of patients very carefully.

[FRI0204] ANALYSIS OF PERIOPERATIVE CLINICAL FEATURES AND COMPLICATIONS AFTER ORTHOPAEDIC SURGERY IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH TOCILIZUMAB: RESULTS FROM THE MULTICENTRE TOPP (TOCILIZUMAB IN PERIOPERATIVE PERIOD) STUDY
S. Momohara1, J. Hashimoto2, T. Suguro3. 1Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; 2Department of Rheumatology, National Hospital Organization, Osaka Minami Medical Centre, Osaka; 3Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, Japan
Conclusions: Many patients treated with tocilizumab keep a normal range of CRP even during the perioperative period. For prevention of perioperative complications, observation of postoperative conditions and surgical wounds, and subjective symptoms of patients are considered important.



Related Blogposts:
http://rheumatologe.blogspot.de/2012/06/tocilizumab-and-leukopenia.html
http://rheumatologe.blogspot.de/2012/06/tocilizumab-monotherapy-vs-humira.html
http://rheumatologe.blogspot.de/2012/05/some-preliminary-notes-on-tocilizumab.html