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Research article
Yves-Marie PERS
CHRU Lapeyronie
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Strategic drug therapy for rheumatoid arthritis (RA) patients with prolonged remission is not well defined. According to recent guidelines, tapering biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs) may be considered. We aimed to evaluate the long-term maintenance of tocilizumab (TCZ) treatment after the progressive tapering of infusions.
Methods
We conducted an exploratory, prospective, single-center, open label study, on RA patients with sustained remission for at least 3 months and treated with TCZ infusions every 4 weeks. The initial re-treatment interval was 6 weeks for the first 3 months. Thereafter, the spacing between infusions was determined by the clinician. Successful long-term maintenance following the tapering of TCZ infusions was defined by patients still treated after two years by TCZ with a minimum dosing interval of 5 weeks.
Results
Thirteen patients were enrolled in the study. Eight out of thirteen were still treated by TCZ after two years. Successful long-term maintenance was possible in six patients, with four patients maintaining a re-treatment interval of 8-weeks or more. We observed 5 patients with TCZ withdrawal: one for adverse drug reaction (neutropenia) and four with secondary failure. Patients achieving successful long-term maintenance with TCZ were significantly younger than those with secondary failure (p<0.05). In addition, RA patients with positive rheumatoid factor and anti-citrullinated peptide antibodies, experienced a significantly greater number of flares during our 2-year follow-up (p<0.01).
Conclusions
A progressive tapering of TCZ infusions seems possible in most of the patients. However, larger studies, including more patients, are needed to confirm this therapeutic option.
Keywords
Rheumatoid arthritis, tocilizumab, maintenance, tapering, remission
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CURRENT STATUS: Published
View the published article at BMC Rheumatology.
No community comments so far
Review #1 received
Received 04 Dec, 2019
Reviewer #2 agreed
On 23 Nov, 2019
Review #2 received
Received 23 Nov, 2019
Editor assigned
On 19 Nov, 2019
Reviewers invited
Invitations sent on 19 Nov, 2019
Reviewer #1 agreed
On 19 Nov, 2019
Submission checks complete
On 18 Nov, 2019
Editor invited
On 18 Nov, 2019
Version 1
Posted 13 Aug, 2019
No comments provided
Editorial decision: Major revision
On 24 Oct, 2019
Review #2 received
Received 12 Oct, 2019
Review #1 received
Received 19 Sep, 2019
Reviewer #2 agreed
On 04 Sep, 2019
Reviewer #1 agreed
On 18 Aug, 2019
Submission checks complete
On 06 Aug, 2019
Reviewers invited
Invitations sent on 06 Aug, 2019
Editor assigned
On 30 Jul, 2019
Editor invited
On 29 Jul, 2019
First submitted
On 26 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Rheumatology
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Rheumatology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Yves-Marie PERS
CHRU Lapeyronie
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Rheumatology.
No community comments so far
Review #1 received
Received 04 Dec, 2019
Reviewer #2 agreed
On 23 Nov, 2019
Review #2 received
Received 23 Nov, 2019
Editor assigned
On 19 Nov, 2019
Reviewers invited
Invitations sent on 19 Nov, 2019
Reviewer #1 agreed
On 19 Nov, 2019
Submission checks complete
On 18 Nov, 2019
Editor invited
On 18 Nov, 2019
Version 1
Posted 13 Aug, 2019
No comments provided
Editorial decision: Major revision
On 24 Oct, 2019
Review #2 received
Received 12 Oct, 2019
Review #1 received
Received 19 Sep, 2019
Reviewer #2 agreed
On 04 Sep, 2019
Reviewer #1 agreed
On 18 Aug, 2019
Submission checks complete
On 06 Aug, 2019
Reviewers invited
Invitations sent on 06 Aug, 2019
Editor assigned
On 30 Jul, 2019
Editor invited
On 29 Jul, 2019
First submitted
On 26 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Rheumatology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Rheumatology.
Background
Strategic drug therapy for rheumatoid arthritis (RA) patients with prolonged remission is not well defined. According to recent guidelines, tapering biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs) may be considered. We aimed to evaluate the long-term maintenance of tocilizumab (TCZ) treatment after the progressive tapering of infusions.
Methods
We conducted an exploratory, prospective, single-center, open label study, on RA patients with sustained remission for at least 3 months and treated with TCZ infusions every 4 weeks. The initial re-treatment interval was 6 weeks for the first 3 months. Thereafter, the spacing between infusions was determined by the clinician. Successful long-term maintenance following the tapering of TCZ infusions was defined by patients still treated after two years by TCZ with a minimum dosing interval of 5 weeks.
Results
Thirteen patients were enrolled in the study. Eight out of thirteen were still treated by TCZ after two years. Successful long-term maintenance was possible in six patients, with four patients maintaining a re-treatment interval of 8-weeks or more. We observed 5 patients with TCZ withdrawal: one for adverse drug reaction (neutropenia) and four with secondary failure. Patients achieving successful long-term maintenance with TCZ were significantly younger than those with secondary failure (p<0.05). In addition, RA patients with positive rheumatoid factor and anti-citrullinated peptide antibodies, experienced a significantly greater number of flares during our 2-year follow-up (p<0.01).
Conclusions
A progressive tapering of TCZ infusions seems possible in most of the patients. However, larger studies, including more patients, are needed to confirm this therapeutic option.
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