48771
document
Interleukin-6 receptor inhibition with tocilizumab and attainment of disease remission in rheumatoid arthritis : the role of acute-phase reactants . OBJECTIVE To determine the effects of tocilizumab on rheumatoid arthritis ( RA ) disease activity and remission assessment , using measures that do or do not comprise acute-phase reactants . METHODS Simplified Disease Activity Index ( SDAI ) scores , Clinical Disease Activity Index ( CDAI ) scores , and the Disease Activity Score in 28 joints ( DAS28 ) were calculated using data from tocilizumab trials in patients with RA in whom disease had remained active despite treatment with disease-modifying antirheumatic drugs . The CDAI does not contain an acute-phase reactant component . Disease activity states , including remission , were defined using established cut points ; for the DAS28 , an alternative cut point of < 2.4 was also used . RESULTS Changes in the DAS28 , the SDAI score , and the CDAI score among patients receiving tocilizumab were significantly higher than those among patients receiving placebo , and the magnitude of these changes was similar for the SDAI and the CDAI . Among patients who achieved 50 % improvement in disease activity according to the American College of Rheumatology criteria , only ∼20 % required a reduction in acute-phase reactant values in order to fulfill the criteria . However , DAS28 remission rates were higher ( even when using the lower cut point ) than the SDAI and CDAI remission rates . Only a minority of tocilizumab-treated patients with DAS28 remission also had disease remission according to the SDAI ( 26 % ) or CDAI ( ∼21 % ) . With infliximab treatment , SDAI and CDAI remission rates were of the same magnitude as those observed with tocilizumab treatment , and DAS28 remission rates were lower . Tocilizumab-treated patients with DAS28 remission but without CDAI remission had significantly higher swollen joint counts but lower erythrocyte sedimentation rates ( ESRs ) compared with patients with SDAI or CDAI remission . CONCLUSION Disease activity in RA is reduced by tocilizumab treatment , irrespective of the type of composite measure used to evaluate disease activity . Remission rates were much higher using the DAS28 compared with the SDAI and CDAI , due to the high weight of the ESR in the DAS28 and the effect of tocilizumab on the ESR . Using the stringent SDAI and CDAI criteria , however , remission rates in patients treated with tocilizumab were in the same range as those seen in patients treated with tumor necrosis factor inhibitors .
48772
Intervention_Pharmacological
tocilizumab
48773
Intervention_Pharmacological
tocilizumab
48774
Intervention_Pharmacological
tocilizumab
48775
Intervention_Pharmacological
disease-modifying antirheumatic drugs
48776
Intervention_Pharmacological
tocilizumab
48777
Intervention_Control
placebo
48778
Outcome_Physical
disease activity
48779
Outcome_Physical
remission assessment
48780
Outcome_Physical
Disease activity states , including remission
48781
Outcome_Physical
Changes in the DAS28
48782
Outcome_Physical
the SDAI score
48783
Outcome_Physical
CDAI score
48784
Outcome_Physical
SDAI
48785
Outcome_Physical
CDAI
48786
Outcome_Physical
improvement in disease activity
48787
Participant_Condition
patients with RA in whom disease had remained active despite treatment with disease-modifying antirheumatic drugs .