AB0325 Examination of cases of long-term biologics-free remission that could be maintained for 1 year or more with tocilizumab
Authors: N. Koido
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Objectives</h3> The clinical characteristics of cases of rheumatoid arthritis in which biologics-free remission was maintained for 1 year or more with tocilizumab (TCZ) treatment were examined. <h3>Methods</h3> Thirteen of 35 patients introduced to TCZ at this clinic have maintained DAS remission (DAS28-ESR&lt;2.6) for 1 year or more. Five of these 13 patients attained biologics-free remission, and three have maintained biologics-free remission for 1 year or more. We examined the clinical characteristics of these three cases. <h3>Results</h3> Case 1 is a 40-year-old woman classified as stage III and class 1, with anti-CCP antibody of 100 U/mL or higher. Treatment before TCZ was NSAIDs and SASP 500 mg/day. Disease duration prior to TCZ introduction was 2 years, DAS28-ESR was 3.5, and HAQ was 0.375. DAS remission was attained after 4 TCZ administrations, and administration was discontinued after 20 administrations when remission was maintained for 14 months. DAS was 0.5 and HAQ was 0.125 at the time of discontinuation. Case 2 is a 42-year-old woman classified as stage II and class 1, with anti-CCP antibody of 70.3 U/mL. Treatment before TCZ was NSAIDs, MTX 8 mg/week and IFX. Due to secondary IFX failure, it was changed to TCZ after 5 administrations. Disease duration prior to TCZ introduction was 15 months, DAS28-ESR was 6.2, and HAQ was 0.5. DAS remission was attained after 4 TCZ administrations, and administration was discontinued after 20 administrations when remission was maintained for 14 months. DAS was 0.97 and HAQ was 0.125 at the time of discontinuation. Case 3 is a 63-year-old woman classified stage II and class 1. Treatment before TCZ was NSAIDs, MTX 10 mg/week and IFX. Due to secondary IFX failure, it was changed to TCZ after 5 years and 4 months. Disease duration prior to TCZ introduction was 7 years, DAS28-ESR was 4.6, and HAQ was 0.75. DAS remission was attained after 4 TCZ administrations, and administration was discontinued after 21 administrations when remission was maintained for 16 months. DAS was 1.85 and HAQ was 0.25 at the time of discontinuation. <h3>Conclusions</h3> The 3 patients who maintained remission for 1 year or more were women. Age was 45.7 years, disease duration was 3.3 years, and classified stage was 2 patients stage II and 1 patient stage IV. Class was class I in all. Tender joint was 2.3, swollen joint was 3.3, and patient GVAS was 62.3 mm. ESR was 47.3 mm/hr, CRP was 1.44 mg/dl, MMP-3 was 555.1 ng/mL, and DAS28-ESR was 4.8. Two of the patients used IFX before TCZ. All three attained DAS remission after 4 TCZ administrations. Administration was stopped after continuing TCZ for 14.7 months after maintaining remission. <h3>Discussion</h3> In comparison of patients who maintained long-term biologics-free remission with the other patients, there was no relation to stage, class or patient GVAS. The treatment before introducing the biological was also unrelated. There was no relation to ESR, CRP or DAS28-ESR, but MMP-3 was high. The time after introducing the biologic until remission was very short at 4 months or less. A TCZ administration period of 1 year or more after maintaining remission was sufficient. DAS28-ESR and HAQ were low at the time of discontinuation. The above suggests that long-term maintenance of biologics-free remission is possible on conditions that discontinuation of TCZ after long-term maintenance of remission status is secured and that sufficient remission status is attained at the time of discontinuation. <h3>Disclosure of Interest</h3> None Declared