Evaluation of the clinical efficiency of tocilizumab therapy, by using DAS 28, SDAI, CDAI indices and new 2011 EULAR/ACR remission criteria in patients with rheumatoid arthritis

Objective: to evaluate the clinical efficiency of tocilizumab (TCZ) from the DAS 28, SDAI, and CDAI indices and to estimate remission rates from the European League Against Rheumatism (EULAR) criteria, and the new remission criteria proposed by the EULAR and the American College of Rheumatology (ACR) in 2011. Subjects and methods. Forty-two patients with rheumatoid arthritis (RA) who had received 6 infusions of TCZ in an intravenous dose of 8 mg/kg at a 4-week interval during stable therapy with disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids were examined. The EULAR criteria based on changes in the DAS 28 index and the SDAI and CDAI activity indices were used to evaluate the efficiency of TCZ therapy. Disease remission was assessed by the EULAR criteria and the new 2011 EULAR/ACR remission criteria. Results. The baseline values (median and interquartile range: 25-75th percentiles) were 6.44 (5.87-7.04) for DAS 28; 45 (36.2-57) for SDAI; and 41.5 (32-53) for CDAI. At week 2 of TCZ therapy, there was a reduction in the levels of DAS 28 to 4.86 (4.28-5.29) and at week 4, there were decreases in SDAI to 22.6 (19.4-29.3) and CDAI to 21.9 (19.3-30), which remained until week 24 (p < 0.01). By week 24 of TCZ therapy, according to the EULAR criteria, 35 and 7 patients were observed to have good and moderate effects, respectively. By week 24, 30 (71%), 13 (31%), and 14 (33%) patients achieved remission according to DAS 28, SDAI, and CDAI, respectively; low DAS 28 (2.6-3.2), SDAI (3.3-11), and CDAI (2.8-10) disease activity was observed in 5 (12%), 21 (50%), and 20 (47.6%) patients, respectively; high SDAI and CDAI activities remained in 2 (4.8%) patients. Remission was observed in 10 (24%) patients according to the 2011 criteria. Conclusion. The obtained results of the 24-week study suggest that TCZ therapy is highly effective according to the changes in DAS 28, SDAI, CDAI activity indices and to the new 2011 EULAR/ACR remission criteria in severe RA resistant to the standard treatment with DMARDs.

DAS 28, SDAI, CDAI, rheumatoid arthritis, tocilizumab, DAS 28, SDAI, CDAI, remission

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