Clinical Observation Of The Efficacy Of Tocilizumab In The Treatment Of Moderate To Severe Rheumatoid Arthritis

Objective:To study the clinical efficacy of tocilizumab combined with anti-rheumatic drugs(DMARDs)for the treatment of moderate to severe active rheumatoid arthritis and the effect on the dosage of glucocorticoids.Methods: Retrospectively collected clinical data of 35 patients with moderate to severe active RA who were admitted to the Department of Rheumatology and Immunology in our hospital from October 2016 to January 2019.Treatment of DMARDs for 12 weeks and regular follow-up visits as the treatment group;35 patients with moderate to severe active RA who were routinely treated with anti-rheumatic drugs(DMARDs)combined with glucocorticoids during the same hospitalization period were selected as the control group.Clinical symptoms,disease activity,daily dose and cumulative dose of methotrexate(MTX),glucocorticoid,and clinical efficacy and adverse reactions were compared between the two groups of patients at 4 and 12 weeks.Results:(1)After 4 weeks of treatment in both groups,all patients' clinical indicators such as erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),rheumatoid factor(RFn),platelet(PLT)and clinical symptoms(morning stiffness,swelling of joints,tender joints,resting pain)? disease activity(DAS-28,SDAI,CDAI)were significantly improved from baseline,compared with the control group without significant changes in HGB levels,the treatment group in the 4 weeks The average HGB level at week(103.65 ± 9.21 g / L)was significantly higher than that at baseline(95.79 ± 13.71 g / L),P <0.01,suggesting that tocilizumab can rapidly improve anemia after treatment;(2)12 weeks of treatment Later,the clinical indicators such as ESR,CRP,RFn,PLT and clinical symptoms(morning stiffness,number of swollen joints,number of tender joints,rest pain)and disease activity(DAS-28,SDAI,CDAI)in the treatment group were higher than 4 weeks.and the improvement in the treatment group was significantly greater than that in the control group(P <0.05);(3)compared with the control group,the cumulative dose of glucocorticoids(equivalent to prednisone 734.56±241.99mg)at 4 weeks of treatment was significantly lower than the control group(1023.53 ± 329.14mg),P <0 01;At 12 weeks of treatment,the cumulative glucocorticoid dose(1036.76 ± 342.18mg)in the treatment group was significantly lower than the control group(1316.91 ± 336.01mg),P <0.01,and the cumulative dose of methotrexate(88.23±35.63mg)at the 12 weeks in the treatment group was significantly lower than the control group(130.58 ± 43.13mg),compared with the control group,tocilizumab can use less cumulative doses of methotrexate and glucocorticoid to achieve clinical remission in the 12-week treatment period.(4)After 12 weeks of treatment,the clinical response rate(CDAI <2.8)in the treatment group was 65.71%,and the rate of low disease activity(2.8?CDAI?10.0)was 31.42%,compared with 14.28% and 68.57% in the control group,The clinical remission rate was significantly better than the control group,the difference was statistically significant(P<0.01);(5)Kaplan-Meier method was used to compare the duration of remission between the two groups of patients,and the median duration of remission was observed in the treatment group at 48 weeks of follow-up,The number was 36 weeks(95% CI:32.25-36.49),while 24 weeks(95% CI: 23.43-28.28)in the control group and the difference was statistically significant.(6)Patients in the treatment group were graded for joint function and X-ray joint staging,duration of disease(<1 year)(OR = 0.285,95% CI: 0.086-0.950),joint function grade I-II(OR = 0.305,95 % CI: 0.113-0.825)and stage X-ray joint stage I-II(OR = 0.41,95% CI: 0.221-0.779),baseline DAS-28(OR = 0.55,95% CI: 0.347-0.877)Response rate of benzumab to RA patients.(7)At 12 weeks of treatment,a total of 7 adverse reactions occurred in two groups,including 3 in the treatment group,2 with upper respiratory tract infection,1 with abnormal liver function,and 4 in the control group.There were 1 case with upper respiratory tract infection and 3 cases with abnormal liver function.Conclusions:Tocilizumab combined with anti-rheumatic drugs(DMARDs)can significantly improve the remission rate and duration of remission in patients with moderate to severe RA,significantly reduce the cumulative dose of combined glucocorticoids,and can be obtained at lower cumulative MTX dose Ease and safety.