• Pnina Langevitz, Merav Lidar, Itzhak Rosner, Joy Feld, Moshe Tishler, Howard Amital, Suhail Aamar, Ori Elkayam, Alexandra Balbir-Gurman, Mahmoud Abu-Shakra, Dror Mevorach, Oded Kimhi, Yair Molad, Ana Kuperman, and Sharon Ehrlich.
• Department of Rheumatology, Sheba Medical Center, Tel Hashomer, Israel.
• Isr Med Assoc J. 2020 Sep 1; 22 (9): 557-563.

BackgroundTocilizumab is an interleukin 6 (IL-6) receptor antagonist used treat moderate to severe active rheumatoid arthritis (RA). Both intravenous (IV) and subcutaneous (SC) routes are approved for the treatment of adults with RA.ObjectivesTo evaluate SC tocilizumab in a real-life clinical setting.MethodsOur study was a multi-center, open-label, single-arm study. Participants were adults with a diagnosis of active RA, previously treated with disease-modifying antirheumatic drugs (DMARDs), with or without biologic agents. Participants received a weekly SC injection of tocilizumab 162 mg as monotherapy or in combination with methotrexate or DMARDs for 24 weeks. Efficacy, safety, and immunogenicity were assessed.ResultsTreatment of 100 patients over 24 weeks resulted in improvement in all efficacy parameters assessed: Clinical Disease Activity Index, Disease Activity Score using 28 joint counts and erythrocyte sedimentation rate, American College of Rheumatology response scores, Simplified Disease Activity Index, tender and swollen joint counts, and patient-reported outcomes including fatigue, global assessment of disease activity, pain, and Health Assessment Quality of Life Disease Index. Improvement was achieved as early as the second week of treatment. There were 473 adverse events (AEs)/100 patient-years (PY) and 16.66 serious AEs/100 PY. The most common AEs were neutropenia (12%), leukopenia (11%), and increased hepatic enzymes (11%). Of a total of 42 PY, the rates of serious infections and AEs leading to discontinuation were 4.8, and 11.9 events/100 PY, respectively.ConclusionsThe safety, tolerability, and efficacy profile of tocilizumab SC were comparable to those reported in other studies evaluating the IV and SC routes of administration.

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