A clinical trial evaluated the effectiveness of Actemra® (tocilizumab) for patients with rheumatoid arthritis (RA) as well as adherence to therapy. These findings were reported in the journal Rheumatology.
Rheumatoid arthritis affects an estimated 1.3 million adults in the United States. The good news is that important advances have been made in the management of RA: use of more effective drugs earlier in the course of RA reduces symptoms and joint damage, and allows some patients to achieve a remission (little or no active disease).
Treatment of RA often begins with methotrexate or another disease-modifying anti-rheumatic drug (DMARD). If this initial treatment does not adequately control the RA, patients may move on to treatment with a newer, biologic DMARD.
Actemra is a type of RA drug known as a biologic. Biologics interfere with specific parts of the immune system that drive inflammation. Actemra, for example, blocks the action of a protein known as IL-6. IL-6 plays a role in inflammation and can contribute to the signs and symptoms of RA by prompting white blood cells to attack certain tissues in the body.
Researchers in Sweden recently sought to evaluate the effectiveness of Actemra for patients with RA as well that rate patients stayed on treatment (adherence) and factors that influenced adherence. The study included 530 patients with RA from a Swedish registry who had been treated with Actemra between September 2008 and March 2012. Of the patients, about 65% were also on treatment with with medications known as disease-modifying antirheumatic drugs (DMARDs), which slow the progression of joint damage from RA. Twelve percent of participants hadn’t previously been treatment with biologics.
The researchers found that 79% of patients continued treatment with Actemra for six months, 64% continued for one year, and 50% continued for two years. They determined that factors linked to stopping treatment with Actemra included a low initial level of C-reactive protein (a marker of inflammation in the body), favorable self-reported status, and previous use of biologics. Simultaneous therapy with DMARDs was not linked to stopping Actemra.
According to the European League Against Rheumatism (EULAR) response criteria, 184 (47%) of patients had a good response to treatment, 133 (34%) had a moderate response, and 77 (20%) had no response. Patients with low self-reported status, a higher number of affected joints, and who weren’t on prednisone at the start of the study were more likely to have a good response to Actemra.
Researchers estimated that 64% of the 530 patients in this study would stay on Actemra for one year. Of these patients, 80% would have a measureable response to treatment. Factors that appeared linked to stopping treatment included a low level of C-reactive protein, good self-reported status, and previous treatment with biologics. Simultaneous treatment with DMARDs did not appear linked to stopping therapy with Actemra.
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Actemra compared with Humira
In a study that compared Actemra® with Humira® (adalimumab) for the treatment of rheumatoid arthritis (RA), Actemra was more effective at reducing RA symptoms. These results were presented at the 2012 annual meeting of the European League Against Rheumatism.
Like Humira, Actemra is also a biologic DMARD, but has a different mechanism of action than Humira. Actemra blocks the action of a protein known as IL-6. IL-6 plays a role in inflammation and can contribute to the signs and symptoms of RA by prompting white blood cells to attack certain tissues in the body. Actemra may be used after treatment with a TNF inhibitor such as Humira has failed.
To directly compare Actemra and Humira, researchers conducted a study among 325 RA patients who could not continue treatment with methotrexate. Patients were treated with either Actemra alone (8 mg/kg IV every 4 weeks) or Humira alone (40 mg subcutaneously every 2 weeks).
- Based on the DAS28 (a commonly used measure of RA activity), patients treated with Actemra had a greater reduction in disease activity than patients treated with Humira.
- Based on ACR20 criteria, 65% of patients treated with Actemra had at least a 20% reduction in symptoms, compared with 49% of patients treated with Humira.
For patients who receive treatment with only a single RA drug and cannot take methotrexate, these results suggest that Actemra may be more effective than Humira.
- Gabay C, Emery P, van Vollenhoven R et al. Tocilizumab (TCZ) monotherapy is superior to adalimumab (ADA) monotherapy in reducing disease activity in patients with rheumatoid arthritis (RA): 24-week data from the phase 4 ADACTA trial. Paper presented at: 2012 Annual Meeting of the European League Against Rheumatism; June 1-5, 2012; Chicago, IL. Abstract LBA0003.
- Forsblad-d’Elia H, Bengtsson K, Kristensen LE, Jacobsson LT. Drug Adherence, Response and Predictors thereof for Tocilizumab in Patients with Rheumatoid Arthritis: Results from the Swedish Biologics Register. Rheumatology. 2014 Dec 13. pii: keu455. [Epub ahead of print].