Comparative effectiveness of tocilizumab with either methotrexate or leflunomide in the treatment of rheumatoid arthritis
Narváez, Javier (Institut d'Investigació Biomèdica de Bellvitge)
Díaz Torne, César (Institut d'Investigació Biomèdica Sant Pau)
Magallares López, Berta Paula (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Hernández, María Victoria (Hospital Clínic i Provincial de Barcelona)
Reina, Delia (Hospital de Sant Joan Despí Moisès Broggi)
Corominas, Hèctor (Hospital de Sant Joan Despí Moisès Broggi)
Sanmartí, Raimon (Hospital Clínic i Provincial de Barcelona)
Rodríguez De La Serna, Arturo (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Llobet, Josep Maria (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Nolla, Joan M. (Institut d'Investigació Biomèdica de Bellvitge)
Universitat Autònoma de Barcelona. Departament de Medicina

Data:	2015
Resum:	Objective: In agreement with EULAR recommendations, a DMARD in combination with a biotherapy is the reference treatment because of the superior long-term clinical and radiographic outcomes. Methotrexate (MTX) is the cornerstone of combination therapy but is in some cases contra-indicated or poorly tolerated. This observational study aimed to compare the effectiveness and safety of TCZ in combination with either MTX or leflunomide (LEF) in the treatment of patients with active rheumatoid arthritis (RA) and an inadequate response to one or more DMARDs and/or biological agents in a real-world setting. Methods: We performed an ambispective review of 91 patients with active RA who were routinely treated with TCZ plus MTX or LEF. A comparative study between the two combinations of treatment was performed at 6 months of follow-up considering 3 outcomes: improvement of RA disease activity, evolution of functional disability, and tolerability and side effect profile. Results: Of the 91 patients, 62 received TCZ with MTX and 29 received TCZ with LEF. Eighty-one patients were followed for 6 months, and the remaining 10 patients discontinued treatment due to serious adverse events. At baseline, there were no significant differences between the groups in terms of the main clinical and laboratory data or in the number of previous DMARDs and biological agents used. At 6 months, there were no significant differences between the combinations in terms of disease activity and functional disability. Serious adverse events occurred in 11% and 10% of the patients treated in combination with MTX and LEF, respectively. Conclusion: Our preliminary data support the argument that LEF is an effective and safe (equivalent) alternative to MTX for combination treatment with TCZ.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Aged ; Antibodies, Monoclonal, Humanized ; Antirheumatic Agents ; Arthritis, Rheumatoid ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Female ; Humans ; Isoxazoles ; Male ; Methotrexate ; Middle Aged ; Neutropenia ; Retrospective Studies ; Treatment Outcome
Publicat a:	PloS one, Vol. 10 Núm. 4 (january 2015) , p. e0123392, ISSN 1932-6203

DOI: 10.1371/journal.pone.0123392
PMID: 25830224

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