Adding tocilizumab or switching to tocilizumab monotherapy in methotrexate inadequate responders: 24-week symptomatic and structural results of a 2-year randomised controlled strategy trial in rheumatoid arthritis (ACT-RAY)
Annals of Rheumatic Diseases,  Clinical Article

Dougados M et al. – No clinically relevant superiority of the TCZ+MTX add–on strategy over the switch to tocilizumab monotherapy strategy was observed. The combination was more commonly associated with transaminase increases. Meaningful clinical and radiographic responses were achieved with both strategies, suggesting that tocilizumab monotherapy might be a valuable treatment strategy in suitable rheumatoid arthritis (RA) patients.

Methods
  • Double-blind, 2-year study in which adults with active RA (DAS28 >4.4) despite methotrexate were randomly assigned either to continue methotrexate with the addition of tocilizumab (MTX+TCZ) 8 mg/kg every 4 weeks or switch to tocilizumab and placebo (TCZ+PBO).
  • The primary endpoint was the DAS28–erythrocyte sedimentation rate (ESR) remission rate at week 24.
  • Secondary objectives included other symptomatic outcomes, quality of life and progression of structural damage.
  • Of 556 randomly assigned patients, 512 (92%) completed 24 weeks.

Results
  • DAS28–ESR remission rates were 40.4% for TCZ+MTX and 34.8% for TCZ+PBO (p=0.19); American College of Rheumatology 20/50/70/90 rates were 71.5%/45.5%/24.5%/5.8% (TCZ+MTX) and 70.3%/40.2%/25.4%/5.1% (TCZ+PBO; differences not significant).
  • A significant difference between groups was seen for low DAS28 (61.7% vs 51.4%).
  • Radiographic progression was small and not different between groups (Genant–Sharp score progression ≤ smallest detectable change in 91% (TCZ+MTX) and 87% (TCZ+PBO)).
  • Rates per 100 patient-years of serious adverse events and serious infections were 21 and six, respectively, for TCZ+MTX and 18 and six, respectively, for TCZ+PBO.
  • Alanine aminotransferase elevations greater than threefold the upper limit of normal occurred in 7.8% and 1.2% of TCZ+MTX and TCZ+PBO patients, respectively.

Please login or register to follow this author.
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Internal Medicine

See All >> Messages include industry-sponsored communications and special communications from MDLinx

<

Most Popular Internal Medicine Articles

1 Acupuncture for chronic knee pain: a randomized clinical trial JAMA, October 1, 2014    Evidence Based Medicine    Clinical Article

2 Calcium and phosphorus intake and prostate cancer risk: A 24-y follow-up study American Journal of Clinical Nutrition, November 26, 2014    Clinical Article

3 Effects of tea intake on blood pressure: A meta-analysis of 21 randomized controlled trials JACC - Journal of the American College of Cardiology, October 22, 2014    Clinical Article

4 Vitamin D and Calcium Supplementation to Prevent Fractures in Adults: U.S. Preventive Services Task Force Recommendation Statement Full Text Annals of Internal Medicine, February 26, 2013    Free full text    Clinical Guideline

5 Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: The ARREST-AF cohort study JACC - Journal of the American College of Cardiology, December 3, 2014    Evidence Based Medicine    Clinical Article

6 The impact of phlebotomy in nonalcoholic fatty liver disease: A prospective randomized controlled trial Hepatology, December 24, 2014    Clinical Article

7 Sweetened carbonated beverage consumption and cancer risk: Meta-analysis and review European Journal of Cancer Prevention, August 1, 2014    Evidence Based Medicine    Review Article

8 Liberal versus restrictive blood transfusion strategy: 3-year survival and cause of death results from the FOCUS randomised controlled trial The Lancet, December 11, 2014    Evidence Based Medicine    Clinical Article

9 Cytisine versus nicotine for smoking cessation New England Journal of Medicine, December 18, 2014    Evidence Based Medicine    Clinical Article

10 P2X3 receptor antagonist (AF-219) in refractory chronic cough: a randomised, double-blind, placebo-controlled phase 2 study The Lancet, December 2, 2014    Evidence Based Medicine    Clinical Article

11 Avoidance of sun exposure is a risk factor for all-cause mortality: results from the MISS cohort Journal of Internal Medicine, April 22, 2014    Evidence Based Medicine    Clinical Article

12 Effect of metformin on left ventricular function after acute myocardial infarction in patients without diabetes: The GIPS-III randomized clinical trial Full Text JAMA, April 16, 2014    Free full text    Evidence Based Medicine    Clinical Article

13 Tea consumption and leukemia risk: A meta-analysis Tumor Biology, February 12, 2014    Evidence Based Medicine    Clinical Article

14 Adherence to the Mediterranean diet is associated with the severity of non-alcoholic fatty liver disease Clinical Nutrition, August 11, 2014    Clinical Article

15 Coffee consumption and risk of nonaggressive, aggressive and fatal prostate cancer - A dose-response meta-analysis Full Text Annals of Oncology, December 2, 2013    Free full text    Evidence Based Medicine    Clinical Article

16 Sodium zirconium cyclosilicate in hyperkalemia New England Journal of Medicine, November 26, 2014    Evidence Based Medicine    Clinical Article

17 Resveratrol levels and all-cause mortality in older community-dwelling adults JAMA Internal Medicine, May 13, 2014    Evidence Based Medicine    Clinical Article

18 Factor XI antisense oligonucleotide for prevention of venous thrombosis New England Journal of Medicine, December 10, 2014    Evidence Based Medicine    Clinical Article

19 Aspirin in type 2 diabetes, a randomised controlled study: effect of different doses on inflammation, oxidative stress, insulin resistance and endothelial function International Journal of Clinical Practice, December 27, 2013    Clinical Article

20 Liberal versus restrictive blood transfusion strategy: 3-year survival and cause of death results from the FOCUS randomised controlled trial The Lancet, December 19, 2014    Evidence Based Medicine    Clinical Article

Indexed Journals in Internal Medicine: New England Journal of Medicine, The Lancet, Archives of Internal Medicinemore

Make smarter career moves with less time.

Sign up for our free job placement service today and have a dedicated career consultant help locate the right physician job for you!
Click Here for more information.

Get Started Now!

Free-of-charge, no obligation.

Terms and Conditions For M3 Career Consult

By registering with the M3 Career Consult service you authorize M3 USA Corporation to represent you in your job search. The following is a summary of the terms of our service and our mutual obligations to help you find a job:

  • You designate M3 to act as your agent and represent you in your job search;
  • You will not pay us for this service
  • You will advise us of any companies or positions to which you apply or have applied;
  • You will advise us if you believe you are not capable of performing a position for which we submit you, or for which you interview;
  • You will keep all information we provide you about companies or positions strictly confidential;
  • You will promptly provide us with information we request of you;
  • You will make yourself reasonably available for phone, video and in-person conversations and interviews;
  • You will be truthful in all of your communications with us; and
  • You will advise us if anything above changes.
 

The Top Read Articles of 2014 are Now Available

Scouring thousands of peer-reviewed journals and popular press, Our Editors just released the Top Read Articles of the Year. See the Top Read List