Improvements in health-related quality of life after treatment with tocilizumab in patients with rheumatoid arthritis refractory to tumour necrosis factor inhibitors: results from the 24-week randomized controlled RADIATE study

Abstract

Objective: To investigate the effect of tocilizumab on patient-reported outcomes (PROs) in RA patients with inadequate responses to TNF inhibitors (TNFis).

Methods: In a Phase III randomized controlled trial, 489 patients received 4 or 8 mg/kg tocilizumab or placebo every 4 weeks plus MTX for 24 weeks. Mean changes from baseline over time and proportions of patients reporting improvements greater than or equal to minimum clinically important differences (MCIDs) in PROs were analyzed.

Results: At week 24, 8 mg/kg resulted in significantly greater improvements vs placebo in pain, global assessment of disease activity (P=0.001), Health Assessment Questionnaire-Disability Index (HAQ-DI; P<0.0001), Functional Assessment of Chronic Illness Therapy-Fatigue (P=0.0150) and Medical Outcomes Survey Short Form 36 (SF-36 v2) Physical Component Summary (PCS; P=0.0003) scores, all greater than MCID; 4 mg/kg resulted in greater improvements in pain (P=0.0100), HAQ-DI (P=0.0030) and SF-36 PCS (P = 0.0020) scores. Tocilizumab-associated improvements were evident as early as week 2. At week 24, more tocilizumab-treated than control patients reported improvements greater than or equal to MCID in SF-36 domain scores and related PROs (50.9-84.9% vs 35.0-51.7%) and achieved ACR50 responses and/or Disease Activity Score 28 (DAS28) remission with PRO improvements greater than or equal to MCID (36.2-51.2% vs 10-20.7% and 10.7-37.5% vs 0.0-3.4%, respectively).

Conclusion: Tocilizumab treatment in patients with inadequate responses to TNFis resulted in rapid and sustained improvements in multiple PROs that were statistically significant and clinically meaningful, consistent with previous efficacy reports. Trial Registration. ClinicalTrials.gov, http://clinicaltrials.gov/, NCT00106522.

Fig. 1

Mean change (s.e.) from baseline in patient pain (A), PtGA (B), HAQ-DI (C) and FACIT-Fatigue scores (D). BL: baseline; NS: not significant; TCZ: tocilizumab. Plotted values are raw mean (s.e.). Week 24 P-values and least squares adjusted means for change from baseline difference between TCZ and controls from the ANOVA model are shown.

Fig. 2

SF-36 domain scores at baseline (A), 16 weeks (B) and 24 weeks (adjusted means) (C) compared with age-/gender-matched US norms using spydergrams. TCZ: tocilizumab. Demarcations on the domain axes represent 10 points (2× MCID). ^aAdjusted means.

Fig. 3

SF-36 PCS and MCS scores: mean change from baseline to week 24. TCZ: tocilizumab. ^aAdjusted least squares means from ANOVA.

Fig. 4

Patients with MCID or greater improvements in PROs at week 24 (A) and patients with improvements in HAQ-DI, patient pain, PtGA or FACIT-Fatigue and corresponding SF-36 domains (B) or clinical outcomes (C). ^aMCIDs: patient pain VAS, ≤−10; PtGA VAS, ≤−10; HAQ-DI, ≤−0.22; FACIT-Fatigue, ≥4; SF-36 PCS, ≥2.5; SF-36 MCS, ≥2.5; SF-36 PF, ≥5; SF-36 RP ≥5; SF-36 BP, ≥5; SF-36 VT, ≥5. TCZ: tocilizumab.