Vol.21 No.4

Original Article

Disease activity score 28 may overestimate the remission induction of rheumatoid arthritis patients treated with tocilizumab: comparison with the remission by the clinical disease activity index

Authors

Shin-ya Kawashiri1 , Atsushi Kawakami1 , Naoki Iwamoto1 , Keita Fujikawa2 , Toshiyuki Aramaki3 , Mami Tamai1 , Satoshi Yamasaki1 , Hideki Nakamura1 , Yukitaka Ueki4 , Kiyoshi Migita5 , Akinari Mizokami6 , Tomoki Origuchi7, Kiyoshi Aoyagi8, Katsumi Eguchi1

  • Unit of Translational Medicine, Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
  • Department of Internal Medicine, Isahaya Health Insurance General Hospital, Nagasaki, Japan
  • Department of Internal Medicine, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
  • Sasebo Chuo Hospital, Center for Rheumatic Disease, Sasebo, Japan
  • Department of General Internal Medicine, NHO National Nagasaki Medical Center, Nagasaki, Japan
  • Department of Internal Medicine, Nagasaki Municipal Hospital, Nagasaki, Japan
  • Nagasaki University School of Health Sciences, Nagasaki University, Nagasaki, Japan
  • Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Received:

27 July 2010

Accepted:

30 November 2010

Published online:

13 January 2011

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Abstract

We evaluated the efficacy of tocilizumab (TCZ) in patients with rheumatoid arthritis (RA) by the clinical disease activity index (CDAI) and disease activity score (DAS) 28-erythrocyte sedimentation rate (ESR). Thirty-two RA patients received 8 mg/kg of TCZ intravenously every 4 weeks for 48 weeks. The therapeutic response was also evaluated in 30 RA patients treated with 3 mg/kg of infliximab (IFX) for 46 weeks. We compared the therapeutic course of TCZ with IFX in order to evaluate the efficacy of TCZ therapy. A strong positive correlation between CDAI and DAS28-ESR was observed at baseline, whereas their associations dropped significantly within the first 2 months. The association recovered to the baseline by IFX, but still remained low in TCZ. Although a decrement of DAS28-ESR was prominent in TCZ as compared with IFX, that of CDAI was significant in the early phase and even in the latter in patients treated by IFX. The present study revealed that DAS28-ESR may not be sufficient to estimate RA disease activity treated by TCZ, probably due to the significant effect toward inhibition of acute phase reactants by TCZ. CDAI is suggested to be an important alternate of composite measure in these cases.

Key words

Rheumatoid arthritis - Tocilizumab - Clinical disease activity index (CDAI)