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Background Rheumatoid arthritis is a systemic disease with various extra-articular symptoms. Anemia is common comorbidity of RA.
Objectives The purpose of this study is to compare the effect of tocilizumab and TNF-α inhibitors on hemoglobin changes and disease activity changes in RA patients. This study aims to determine whether tocilizumab is more effective in controlling hemoglobin elevation and disease activity in patients with anemia.
Methods The data in this study derived from the Korean College of Rheumatology Biologics (KOBIO) registry. OF the patients registered in KOBIO registry, patients using tocilizumab and TNF-α inhibitors were enrolled in this study. To exclude the effects of previously used biologic DMARDs, patients who started the first biologic DMARDs and have been using one biologic DMARD for more than 1 year were included in this study. Anemia was defined as Hb levels <12.0 g/dL in women and <13.0 g/dL in men according to the World Health Organization (WHO) criteria at index date.
Results Among rheumatoid arthritis patients with anemia, there were 126 patients in the tocilizumab group and 248 patients in the TNF-α inhibitor group. Initial and follow-up data collected after 1 year of biologic use were analyzed. After initiation of treatment, Hb and Hct were significantly elevated in tocilizumab group. Mean increases in Hb and Hct were 1.56 and 3.53 in tocilizumab group, 1.02 and 2.64 in TNF-α inhibitor group. DAS28-ESR and RAPID3 decreased significantly in tocilizumab group after using biologics. In tocilizumab group, DAS28-ESR decreased by 3.35 and RAPID3 decreased by 8.31. The changes in SJC, PGA, PhGA, SDAI and CDAI were not different between the two groups. Multivariate analysis was performed using the TNF-α inhibitor group as a control. Tocilizumab was more effective than TNF-α inhibitors in increasing Hb.
Conclusion In RA patients with anemia, although tocilizumab was more effective than TNF inhibitors in increasing Hb, there was no difference between the two drugs in controlling disease activity. During the course of this research, the results of the DAS28-ESR and other outcome measures did not match. In patients treated tocilizumab, assessment of disease activity using the DAS28-ESR may be overestimated due to its effect on acute phase reactant values.
| Tocilizumab (n=126) | TNFi (n=248) | Between-Group Difference in Change | p-valuea | |||
|---|---|---|---|---|---|---|
| Measurement | Baseline | 1 year change | Baseline | 1 year change | ||
| HB | 10.95 (10.77, 11.13) | 1.56 (1.33, 1.80) | 11.04 (10.93, 11.15) | 1.02 (0.86, 1.18) | 0.55 (-2.00, 3.09) | <.001 |
| HCT | 34.05 (33.60, 34.51) | 3.53 (2.90, 4.17) | 34.07 (33.76, 34.38) | 2.64 (2.20, 3.09) | 0.89 (-6.05, 7.84) | .013 |
| TJC | 7.63 (6.68, 8.58) | -5.97 (-6.92, -5.02) | 9.40 (8.46, 10.35) | -7.43 (-8.32, -6.54) | 1.46 (-10.79, 13.72) | .023 |
| PTGA | 7.14 (6.79, 7.48) | -3.76 (-4.20, -3.31) | 6.88 (6.64, 7.13) | -3.51 (-3.86, -3.16) | -0.25 (-5.48, 4.98) | .370 |
| PhGA | 6.25 (5.93, 6.57) | -3.39 (-3.80, -2.98) | 6.59 (6.35, 6.82) | -3.67 (-4.01, -3.32) | 0.28 (-4.69, 5.24) | .288 |
| ESR | 53.84 (48.78, 58.90) | -43.31 (-48.37, -38.24) | 55.7 (52.12, 59.28) | -26.85 (-30.59, -23.10) | -16.46 (-73.46, 40.54) | <.001 |
| CRP | 3.08 (2.47, 3.68) | -2.75 (-3.39, -2.12) | 2.69 (2.33, 3.06) | -1.87 (-2.28, -1.47) | -0.88 (-7.56, 5.80) | .015 |
| SDAI | 29.8 (27.87, 31.73) | -20.68 (-22.74, -18.62) | 30.27 (28.89, 31.65) | -20.64 (-22.18, -19.10) | -0.04 (-23.38, 23.30) | .914 |
| CDAI | 26.73 (24.94, 28.52) | -17.93 (-19.86, -16.00) | 27.58 (26.29, 28.87) | -18.75 (-20.17, -17.33) | 0.83 (-20.86, 22.51) | .377 |
| SJC | 6.62 (5.76, 7.48) | -5.57 (-6.45, -4.69) | 7.53 (6.79, 8.26) | -6.37 (-7.07, -5.67) | 0.80 (-9.52, 11.11) | .144 |
| DAS28-ESR | 5.68 (5.49, 5.87) | -3.35 (-3.58, -3.12) | 5.77 (5.65, 5.89) | -2.59 (-2.77, -2.41) | -0.76 (-3.39, 1.87) | <.001 |
| RAPID3 | 16.66 (15.63, 17.69) | -8.31 (-9.42, -7.19) | 15.23 (14.5, 15.97) | -6.82 (-7.65, -5.99) | -1.49 (-14.09, 11.12) | .034 |
REFERENCES:
NIL.
Acknowledgements: NIL.
Disclosure of Interests None Declared.
Keywords: bDMARD, Rheumatoid arthritis
DOI: 10.1136/annrheumdis-2023-eular.4237