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Neutrophil count reduction 1 month after initiating tocilizumab can predict clinical remission within 1 year in rheumatoid arthritis patients
- Source :
- Rheumatology International. 42:1983-1991
- Publication Year :
- 2021
- Publisher :
- Springer Science and Business Media LLC, 2021.
-
Abstract
- Neutropenia is a common adverse event of tocilizumab (TCZ) in rheumatoid arthritis (RA) patients; however, the association between the decrease in neutrophil counts and the TCZ clinical efficacy remains inconclusive. This study aimed to examine whether TCZ-induced neutrophil decrease at 1 month predicts clinical remission within 1 year. We reviewed medical records of RA patients initiating TCZ between May 2011 and September 2019 in our hospital. The Clinical Disease Activity Index (CDAI) was evaluated at baseline (before initiating TCZ) and 1, 3, 6, and 12 months after administration. Clinical remission was defined when CDAI decreased ≤ 2.8. The ratio of neutrophil counts 1 month after initiating TCZ to those at baseline (neutrophil ratio) was also calculated. Among 255 TCZ-treated patients, 169 with valid CDAI and neutrophil counts were enrolled (with median age of 60 years and 79% females). Rheumatoid factor and anti-cyclic citrullinated peptide antibody were positive in 75% and 83%, respectively, and 56% of the patients had concomitant methotrexate (median dose: 8 mg/week). Multivariate logistic regression analysis suggested baseline CDAI (odds ratio (OR) 0.96, p = 0.045), concomitant PSL (OR 0.42, p = 0.030), and the neutrophil ratio (OR 0.19, p = 0.011) as predictors of CDAI remission. Neutrophil ratio ≤ 0.8 was associated with achieving remission (Fisher's exact test, p = 0.02) with no apparent increase of severe infection. More than 20% reduction of neutrophil count 1 month after initiating TCZ predicts clinical remission within 1 year at an early treatment phase.
- Subjects :
- Male
medicine.medical_specialty
Neutrophils
Immunology
Neutropenia
Antibodies, Monoclonal, Humanized
Severity of Illness Index
Gastroenterology
Arthritis, Rheumatoid
chemistry.chemical_compound
Tocilizumab
Rheumatology
Rheumatoid Factor
Internal medicine
medicine
Humans
Immunology and Allergy
Rheumatoid factor
business.industry
Remission Induction
Odds ratio
Middle Aged
medicine.disease
Methotrexate
Treatment Outcome
chemistry
Antirheumatic Agents
Concomitant
Rheumatoid arthritis
Absolute neutrophil count
Female
business
Subjects
Details
- ISSN :
- 1437160X
- Volume :
- 42
- Database :
- OpenAIRE
- Journal :
- Rheumatology International
- Accession number :
- edsair.doi.dedup.....04da74567d219f865ee73411ea505b95