D.A. Pappas, MD, Columbia University, New York, New York; Corrona, LLC, Waltham, Massachusetts;
C.J. Etzel, PhD, M. Crabtree, MPH, T. Blachley, MS, Corrona, LLC, Waltham, Massachusetts.
J Rheumatol. 2020 Oct 1;47(10):1464-1474. doi: 10.3899/jrheum.190282. Epub 2020 Jan 15.
Comorbidity burden and obesity may affect treatment response in patients with rheumatoid arthritis (RA). Few real-world studies have evaluated the effect of comorbidity burden or obesity on the effectiveness of tocilizumab (TCZ). This study evaluated TCZ effectiveness in treating RA patients with high versus low comorbidity burden and obesity versus nonobesity in US clinical practice.
Patients in the Corrona RA registry who initiated TCZ were stratified by low or high comorbidity burden using a modified Charlson Comorbidity Index (mCCI) and by obese or nonobese status using body mass index (BMI). Improvements in disease activity and functionality after TCZ initiation were compared for the above strata of patients at 6 and 12 months after adjusting for statistically significant differences in baseline characteristics.
We identified patients with high (mCCI ≥ 2; n = 195) and low (mCCI < 2; n = 575) comorbidity burden and patients categorized as obese (BMI ≥ 30; n = 356) and nonobese (BMI < 30; n = 449) who were treated with TCZ. Most patients (> 95%) were biologic experienced and about one-third of patients received TCZ as monotherapy, with no significant differences between patients by comorbidity burden or obesity status. Improvement in disease activity and functionality at 6 and 12 months was similar between groups, regardless of comorbidity burden or obesity status.
In this real-world analysis, TCZ was frequently used to treat patients with high comorbidity burden or obesity. Effectiveness of TCZ did not differ by comorbidity or obesity status.
合并症负担和肥胖可能会影响类风湿关节炎（RA）患者的治疗反应。很少有真实世界的研究评估合并症负担或肥胖对托珠单抗（TCZ）疗效的影响。本研究评估了 TCZ 在治疗美国临床实践中合并症负担较高或较低和肥胖或非肥胖的 RA 患者中的疗效。
Corrona RA 登记处中接受 TCZ 治疗的患者根据改良 Charlson 合并症指数（mCCI）分为合并症负担低（mCCI < 2）或高（mCCI ≥ 2），根据体重指数（BMI）分为肥胖（BMI ≥ 30）或非肥胖（BMI < 30）。在调整基线特征的统计学差异后，比较 TCZ 治疗后 6 个月和 12 个月上述患者亚组的疾病活动度和功能改善情况。
我们确定了接受 TCZ 治疗的合并症负担高（mCCI ≥ 2；n = 195）和低（mCCI < 2；n = 575）以及肥胖（BMI ≥ 30；n = 356）和非肥胖（BMI < 30；n = 449）的患者。大多数患者（> 95%）为生物制剂经验丰富，约三分之一的患者接受 TCZ 单药治疗，合并症负担或肥胖状况不同的患者之间无显著差异。6 个月和 12 个月时，疾病活动度和功能改善在各组之间相似，无论合并症负担或肥胖状况如何。
在这项真实世界的分析中，TCZ 经常用于治疗合并症负担高或肥胖的患者。TCZ 的疗效不因合并症或肥胖状况而异。
