Tocilizumab as Monotherapy or Combination Therapy for Treating Active Rheumatoid Arthritis: a Meta-analysis of efficacy and Safety Reported in Randomized Controlled Trials
This is the first meta-analysis comparing efficacy and safety of TCZ monotherapy (TCZMONO) versus TCZ + csDMARD (TCZCOMBI) in patients with RA. The findings show that similar efficacy can be expected with TCZ monotherapy in patients with intolerance to csDMARDs compared with inadequate responders to csDMARDs who switch to TCZ add-on therapy.
A total of 6679 patients from 13 studies were included, receiving: 1298, TCZMONO; 3077, TCZCOMBI; 2204, csDMARDs. Meta-analyses were performed for the following therapy comparisons: TCZMONO versus TCZCOMBI; TCZMONO versus csDMARD; and TCZCOMBI versus csDMARD.
With TCZMONO and TCZCOMBI therapies, pooled effect estimates of DAS28 <2.6 were significantly higher compared with csDMARD therapy. TCZCOMBI was marginally superior to TCZMONO in terms of achieving DAS28 <2.6 and ACR50 response, however this was at the cost of increased serious adverse events.
In the management of RA in clinical practice, switching to TCZ monotherapy is a good option for patients who cannot tolerate csDMARDs. TCZ is the first bDMARD to show similar efficacy when used as monotherapy or combination therapy.