SAT0156 METHOTREXATE DISCONTINUATION AND DOSE DECREASES AFTER THERAPY WITH TOCILIZUMAB: RESULTS FROM THE CORRONA RHEUMATOID ARTHRITIS REGISTRY
Authors: Dimitrios A. Pappas, Taylor Blachley, Steve Zlotnick, Jennie H. Best, Kelechi Emeanuru, Joel Kremer
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Methotrexate (MTX) is frequently prescribed with biologic disease-modifying antirheumatic drugs. Evidence has shown that tocilizumab (TCZ) monotherapy is effective in the treatment of patients with rheumatoid arthritis (RA).<sup>1,2</sup> Similar outcomes have been shown in patients responding to TCZ combination therapy who discontinued MTX or remained on combination therapy.<sup>3</sup> <h3>Objectives:</h3> To examine MTX discontinuation and dose decreases in patients with RA initiating TCZ and to describe disease activity outcomes in a real-world setting. <h3>Methods:</h3> TCZ-naïve patients enrolled in the Corrona RA Registry who initiated TCZ and had a 6-month follow-up visit without discontinuation of TCZ were included. Patients were grouped by MTX dose at the time of TCZ initiation (≤ 10 mg, &gt; 10 to ≤ 15 mg, &gt; 15 to ≤ 20 mg, &gt; 20 mg). The primary outcome was the proportion of patients with changes in MTX use at 6 months. Changes in disease activity (Clinical Disease Activity Index [CDAI]) and patient-reported outcomes (PROs) over the follow-up period are described. <h3>Results:</h3> Of 444 eligible patients, 82.7% were female, and 83.7% were white, with a mean (SD) disease duration of 11.6 (9.3) years and a baseline CDAI score of 24.0 (15.4). The mean (SD) MTX dose at baseline was 17.7 (5.8) mg. Overall, a total of 139 patients (31.3%) discontinued or decreased MTX at 6 months (overall mean [SD] dose change, −3.0 [7.5] mg); across baseline MTX dose groups, the proportion of patients who discontinued or decreased MTX at 6 months ranged from 28.2% to 38.2%. Improvements in CDAI scores and PROs were observed at 6 months in all baseline MTX dose groups and in patients who discontinued, decreased, maintained, or increased MTX doses at 6 months (<b>Table 1</b>). Similar patterns and results were observed at 12 months (not shown). <h3>Conclusion:</h3> A considerable proportion of patients initiating TCZ were able to discontinue or decrease the dose of MTX after TCZ initiation. Patients who were able to discontinue or decrease MTX experienced similar improvements in disease activity and functionality. Discontinuing or decreasing MTX may be an effective treatment strategy for patients initiating TCZ combination therapy. <h3>References</h3> [1] Bykerk VP, et al. Clin Rheumatol. 2015;34(3):563-571. [2] Jones G, et al. Ann Rheum Dis. 2010;69(1):88-96. [3] Kremer J, et al. Arthritis Rheumatol. 2018;70(8):1200-1208. <h3>Acknowledgement:</h3> This study was sponsored by Corrona, LLC, and the analysis was funded by Genentech, Inc. Access to study data was limited to Corrona, and Corrona statisticians completed all of the analyses; all authors contributed to the interpretation of the results. Corrona has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Crescendo, Eli Lilly and Company, Genentech, Gilead, GSK, Janssen, Merck, Momenta Pharmaceuticals, Novartis, Pfizer Inc, Regeneron, Roche, Sun, UCB and Valeant. <h3>Disclosure of Interests:</h3> Dimitrios A Pappas Grant/research support from: AbbVie, Consultant for: AbbVie, Employee of: Corrona, Taylor Blachley Employee of: Corrona, LLC, Steve Zlotnick Shareholder of: Genentech, Employee of: Genentech, Jennie H. Best Shareholder of: Genentech, Employee of: Genentech, Kelechi Emeanuru Employee of: Corrona, LLC, Joel Kremer Shareholder of: Corrona, Consultant for: AbbVie, Amgen, Bristol-Myers Squibb, Genentech, GSK, Lilly, Pfizer, Regeneron and Sanofi, Employee of: Corrona