Tocilizumab improves anaemia markers in RA patients
Treatment with interleukin (IL)-6 inhibitor tocilizumab improves anaemia markers in patients with rheumatoid arthritis (RA) compared with other disease-modifying antirheumatic drugs (DMARDs), real-world data have shown.
“Treatment with tocilizumab was associated with significant improvement in haemoglobin and haematocrit levels after adjusting for confounding factors, whereas other biologic DMARDs or tofacitinib were significantly less effective,” said lead author Dr Sanjoy Paul of the University of Melbourne and Melbourne Health in Australia.
At 24 months, mean haemoglobin and haematocrit levels increased by an average of 0.23 g/dL and 0.96 percent, respectively in those treated with tocilizumab, regardless of baseline anaemia status. Among anaemic RA patients in the tocilizumab group, haemoglobin and haematocrit levels increased by 0.72 g/dL and 2.06 percent, respectively. [Semin Arthritis Rheum 2017;doi:http://dx.doi.org/10.1016/j.semarthrit.2017.08.001]
“Our robust analyses suggest an almost twofold higher likelihood of achieving increased haemoglobin levels within 6 months of therapy in patients who initiated tocilizumab within 1 year of diagnosis of RA vs those who initiated later,” Paul said.
Anaemia is often present in active RA, but its aetiology is multifactorial and clinical response to treatment varies considerably from patient to patient. “We are not aware of any study that evaluated the possible association of various antirheumatic therapies in a holistic way in the real-world setting. There was also a dearth of studies looking at the potential benefits of early initiation of biologic DMARDs on anaemia markers.”
Using large primary/ambulatory care patient data, Paul and his colleagues sought to evaluate the changes in haemoglobin and haematocrit levels after months of initiating tocilizumab, tofacitinib, and other nonbiologic DMARDs in
153,788 RA patients listed in the Centricity Electronic Medical Record database in the US. All patients were on background DMARDs. Over 70 percent were female. Average age was 58 and 43 percent were obese.
Of the full study cohort, 3,762 were taking tocilizumab, 3,126 were on tofacitinib, 55,964 were taking other biologic DMARDs, and 91.236 nonbiologic DMARDs.
At the index date (first prescription of RA drug), anaemic patients in each group ranged from 21 to 29 percent. Those treated with tocilizumab were 86 percent more likely to increase haemoglobin by ≥1 g/dL vs patients treated with other biologic and nonbiologic DMARDs within 6 weeks of treatment initiation. No clinically significant changes in haemoglobin were seen in other groups.
The study is not without caveats as there was incomplete data on drug adherence and doses, side effects, disease activity, and pain scores.
“One of the novelties of the trial [though] is the evaluation of the possible benefits of early initiation of IL-6 based therapies in patients diagnosed with RA for more efficient short-and long-term control of anaemia markers,” said Paul.
Whether the improvement in anaemia markers seen with tocilizumab in the study corresponds to better disease control and meaningful improvements in quality of life remains to be elucidated in future studies, he added.