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Major reduction of ultrasound-detected synovitis during subcutaneous tocilizumab treatment: results from a multicentre 24 week study of patients with rheumatoid arthritis

Research output: Contribution to journalJournal articleResearchpeer-review

  • H B Hammer
  • Imj Hansen
  • P Järvinen
  • M Leirisalo-Repo
  • M Ziegelasch
  • B Agular
  • L Terslev
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Objective: Few studies have investigated the efficacy of subcutaneous tocilizumab (TCZ-SC) on ultrasound-detected inflammation. This study aimed to explore the clinical efficacy of TCZ-SC treatment in rheumatoid arthritis (RA) patients and to evaluate the response by ultrasound compared to Composite Disease Activity Scores (CDAS).Method: This open-label, single-arm study enrolled RA patients with inadequate response to conventional synthetic disease-modifying anti-rheumatic drugs initiating TCZ-SC 162 mg once weekly for 24 weeks, with clinical assessments at baseline, 2, 4, 8, 12, 16, 20, and 24 weeks. Ultrasound examinations [semi-quantitative score (0-3) of 36 joints and four tendons] were performed at baseline, 4, 12, and 24 weeks. CDAS and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) response, and sum scores of ultrasound grey scale/Doppler were calculated. Changes during follow-up were explored by the Mann-Whitney test and correlations by Spearman's rho.Results: In total, 133 patients (mean ± sd age 55.9 ± 12.0 years) were assessed clinically and 110 patients were also examined with ultrasound. All clinical and ultrasound scores decreased significantly after 4 weeks (p < 0.001). At 24 weeks there was EULAR good response in 87.7% and ACR 70% response in 47.4%. Ultrasound scores had no or low correlations with patient-reported outcomes. At 24 weeks, CDAS remission was achieved in 27.4-83.5% and a sum score Doppler of 0 was found in 53.3%.Conclusions: Clinical and ultrasound scores decreased rapidly. Ultrasound scores were not associated with patient-reported variables. Half of the patients reached ultrasound remission, while there were large discrepancies in the percentage of patients reaching remission based on different CDAS.Trial registration: Study ML28691, registered 28 January 2014, identifier: NCT02046616.

Original languageEnglish
JournalScandinavian Journal of Rheumatology
Issue number4
Pages (from-to)262-270
Number of pages9
Publication statusPublished - Jul 2021

Bibliographical note


    Research areas

  • Adult, Aged, Antibodies, Monoclonal, Humanized/therapeutic use, Antirheumatic Agents/therapeutic use, Arthritis, Rheumatoid/diagnostic imaging, Female, Humans, Male, Middle Aged, Remission Induction, Severity of Illness Index, Synovitis/diagnostic imaging, Treatment Outcome, Ultrasonography

ID: 74742999