J Korean Med Sci.  2022 May;37(17):e138. 10.3346/jkms.2022.37.e138.

Predictive Factors for Rheumatoid Arthritis Flare After Switching From Intravenous to Subcutaneous Formulation of Tocilizumab in RealWorld Practice

• Ahn SM
• Oh JS
• Heo HM
• Hong S
• Lee CK
• Yoo B
• Kim YG

• KMID: 2529705
• DOI: http://doi.org/10.3346/jkms.2022.37.e138

Abstract

Background
To evaluate the incidence and related factors of rheumatoid arthritis (RA) flares after switching from intravenous tocilizumab (TCZ-IV) to subcutaneous tocilizumab (TCZSC) injection in stable RA patients.
Methods
We retrospectively evaluated the medical records of stable RA patients who used TCZ-IV for more than 6 months and switched to TCZ-SC between January 2013 and April 2020. RA flare was defined as an increase of more than 1.2 in the RA disease activity as assessed by the disease activity score in 28 joints. The factors associated with RA flare were evaluated by logistic regression analysis.
Results
Among 106 patients treated with TCZ-IV for > 6 months, 37 patients were switched to TCZ-SC after the acquisition of remission or low disease activity. RA flares occurred in 11 (29.7%) of patients who switched TCZ-SC. Results from the multivariable logistic analysis revealed that the dose of TCZ-IV per weight at switching (odds ratio [OR], 20.70; 95% confidence interval [CI], 2.22–192.84; P = 0.008) and methotrexate (MTX) non-use (OR, 8.53; 95% CI, 1.21–60.40; P = 0.032) were associated with the risk of RA flares after switching to TCZ-SC. Interestingly, most patients who switched back to TCZ-IV had their RA activity controlled again.
Conclusion
MTX non-use and high dose of TCZ-IV per weight were associated with a risk of RA flare after switching to TCZ-SC. RA patients with these factors need to be carefully observed for flare after switching from TCZ-IV to TCZ-SC.

Keyword

Rheumatoid Arthritis; Tocilizumab; Subcutaneous Injections; Drug Administration Routes

Figure

• 

  Fig. 1 Flowchart of the patient selection process.TCZ = tocilizumab, SC = subcutaneous, IV = intravenous, F/U = follow-up.

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