Successful long-term remission through tapering tocilizumab infusions: a single-center prospective study

Chayma Ladhari (1) , Pierre Le Blay (1) , Thierry Vincent (2, 3) , Ahmed Larbi (4) , Emma Rubenstein (1) , Rosanna Ferreira Lopez (1) , Christian Jorgensen (1) , Yves-Marie Pers (1)

1 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)
2 CHRU Montpellier - Hôpital Saint Eloi
3 INM - Institut des Neurosciences de Montpellier
4 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes

Abstract Background Strategic drug therapy for rheumatoid arthritis (RA) patients with prolonged remission is not well defined. According to recent guidelines, tapering biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) may be considered. We aimed to evaluate the effectiveness of long-term maintenance of tocilizumab (TCZ) treatment after the progressive tapering of infusions. Methods We conducted an exploratory, prospective, single-center, open-label study, on RA patients with sustained remission of at least 3 months and treated with TCZ infusions every 4 weeks. The initial re-treatment interval was extended to 6 weeks for the first 3 months. Thereafter, the spacing between infusions was determined by the clinician. Successful long-term maintenance following the tapering of TCZ infusions was defined by patients still treated after two years by TCZ with a minimum dosing interval of 5 weeks. Results Thirteen patients were enrolled in the study . Eight out of thirteen were still treated by TCZ after two years . Successful long-term maintenance was possible in six patients, with four patients maintaining a re-treatment interval of 8-weeks or more. We observed 5 patients with TCZ withdrawal: one showing adverse drug reaction (neutropenia) and four with secondary failure. Patients achieving successful long-term maintenance with TCZ were significantly younger than those with secondary failure ( p < 0.05). In addition, RA patients with positive rheumatoid factor and anti-citrullinated peptide antibodies, experienced a significantly greater number of flares during our 2-year follow-up ( p < 0.01). Conclusions A progressive tapering of TCZ infusions may be possible for many patients. However, larger studies, including more patients, are needed to confirm this therapeutic option.

Mots clés: Maintenance; Remission; Rheumatoid arthritis; Tapering; Tocilizumab

Domaines: Sciences du Vivant [q-bio]

Chayma Ladhari, Pierre Le Blay, Thierry Vincent, Ahmed Larbi, Emma Rubenstein, et al.. Successful long-term remission through tapering tocilizumab infusions: a single-center prospective study. BMC Rheumatology, 2020, 4 (1), ⟨10.1186/s41927-019-0109-0⟩. ⟨hal-03474664⟩