A national, multicenter, retrospective study evaluating retention rate and efficacy of tocilizumab treatment in patients with active rheumatoid arthritis who had an inadequate response to csDMARDs and/or TNF inhibitors.

BACKGROUND: To describe the disease activity and retention rate in rheumatoid arthritis (RA) patients with inadequate response (IR) to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and/or tumor necrosis factor inhibitors (TNFis) who were prescribed tocilizumab (TCZ) as first-line or second-line biologic treatment in real-world setting. METHODS: Data gathered from patients' files was used in a multicenter and retrospective context. Retention rates and the Disease Activity Score in 28 joints with CRP (DAS28-CRP) were evaluated at time points. The relationship of drug efficacy with factors such as smoking, obesity, and previous use of TNFis was also examined. RESULTS: One hundred and twenty-four patients with a median (IQR) RA duration of 3.7 (7.4) years were included. Mean (SD) age was52.9 (12.9) and 75% of the patients were female. TCZ retention rates in the 6th and 12th months were 94.1% and 86.6%, respectively. In all patients, DAS28-CRP level decreased significantly from baseline to Months 3 and 6. There was an increase in patients with remission and/or low disease activity and a decrease in patients with high disease activity at Month 3 and Month 6 (p < 0.001 for both). Disease activity was similar between subgroups based on body mass index, smoking status, and previous use of TNFis at any time point. Regression analysis showed that absence of concomitant corticosteroid treatment independently was associated with remission/LDA achievement at Month 6 [OR = 0.31, 95% CI (0.14- 0.72), p = 0.006], and Month 12 [OR = 0.35, 95% CI (0.13-0.94), p = 0.037]. Overall, 25 mild adverse events were reported. DISCUSSION: TCZ was found to be effective and safe in RA patients with IR to csDMARDs and/or TNFis. The drug retention rate was considered satisfactory with more than half of the patients continuing TCZ treatment at Month 12.

Use of non-TNF biologics for the treatment of neuro-Behçet's disease: Literature review and 2 refractory cases of monoclonal anti-TNFs treated with tocilizumab.

Neurological complications of BD (neuro-Behçet's disease [NBD]) are life-threatening and disabling manifestations. Neurological involvement occurs in approximately 5% to 18% of patients with BD. Most patients with NBD respond well to glucocorticoids, cyclophosphamide, or anti-tumor necrosis factors (TNFs), but there are some resistant cases refractory to these drugs. This study aims to summarize the existing data on the management of NBD, with special focus on patients resistant to anti-TNFs. The study included a short review of early treatment steps. In addition to a literature review of treatment with non-TNF biologics, we present 2 NBD cases with neurological involvement that are resistant to standard high-dose steroid therapy and anti-TNF treatment. Both patients responded well to the tocilizumab therapy, and there was no serious adverse event.