Patients who cannot tolerate cDMARDs may experience additional value from tocilizumab compared to adalimumab.
Joseph Dang, PharmD
Results of a network meta-analysis demonstrate similar efficacy between both intravenous and subcutaneous tocilizumab and other targeted immune modulators for patients with rheumatoid arthritis.
The findings, which were published as part of the European E-Congress of Rheumatology 2020 (EULAR 2020) meeting, suggested tocilizumab had similar efficacy when used in combination with a conventional disease-modifying antirheumatic drug (cDMARD) among targeted immune modulator-naïve and mixed patient populations.
Joseph Dang, PharmD, from Genentech, and investigators from IQVIA evaluated the efficacy of combination tocilizumab plus cDMARD to other targeted immune modulators plus a cDMARD in targeted immune modulator-naïve or mixed adults with moderate to severe rheumatoid arthritis. What’s more, the team aimed to see the efficacy of tocilizumab monotherapy to other targeted immune modulator monotherapies in naïve or mixed adults with moderate to severe rheumatoid arthritis. The team defined efficacy as the achievement of an ACR20 response or better at 24 weeks.
Dang and the investigative team selected randomized controlled trials from a systematic literature review conducted by the Institute for Clinical and Economic Review, along with a trial for upadacitinib (SELECT-COMPARE). Treatments in the trials included Janus kinase (JAK) inhibitors (upadacitinib, baricitinib, and tofacitinib), tumor necrosis factor-alpha inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab), and other non-tumor necrosis factor inhibitors (rituximab, sarilumab, tocilizumab, and abatacept).
The investigators included a total of 35 studies of combination therapies with a pooled population of 17,508 patients. Populations were predominantly female (79%) and patients were a mean age of 52 years old (range, 47-58 years old). The mean disease duration was 8 years and the mean Disease Activity Score 28 (DAS28) score was 6 (range, 5-7).
In comparison with cDMARDS, targeted immune modulators were 1.69-2.22 times more likely to achieve an ACR20 response or better at 24 weeks, which was statistically significant. In a pair-wise comparison, intravenous and subcutaneous tocilizumab did not differ from other targeted immune modulators, including JAK inhibitors.
The team conducted a monotherapy analysis, in which 5 studies were included for a total patient population of 1189. Once again, the populations were predominantly female (mean, 82%; range, 75-90). The mean age at baseline was 53 years old (range, 51-54 years old), with a mean disease duration of 6 years (range, 2-9), and a mean DAS28 score of 6 (range, 5-7).
Dang and the investigators compared cDMARDS to targeted immune modulators and found all targeted immune modulators were 1.65-1.84 times more likely to achieve ACR20 response or better, which was statistically significant. In a pair-wise comparison, intravenous tocilizumab was associated with a greater likelihood of achieving an ACR20 response or better compared to adalimumab (RR, 1.1; 95% CI, 1.03-1.29).
Overall, the team found there was similar efficacy between intravenous and subcutaneous tocilizumab and other targeted immune modulators, including new JAK inhibitors, when used in combination with a cDMARD. The investigators noted patients who cannot tolerate cDMARDs may experience additional value from tocilizumab compared to adalimumab.
The study, “Comparative Efficacy (ACR 20) of Tocilizumab to Other Targeted Immune Modulators (TIM) For Rheumatoid Arthritis: A Network Meta-Analysis (NMA),” was published online on the EULAR 2020 website.