FRI0099 PREDICTIVE FACTORS FOR REMISSION ACHIEVEMENT BY TOCILIZUMAB MONOTHERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS AFTER INADEQUATE RESPONSE TO METHOTREXATE: A POST HOC ANALYSIS OF THE SURPRISE STUDY

Background: Interleukin (IL)-6 pathway inhibitors are suggested by European League Against Rheumatism recommendations to have some advantages in rheumatoid arthritis (RA) patients who are not suitable to use methotrexate as comedication compared with other biological disease-modifying antirheumatic drugs. However, it remains to be elucidated what predicts remission achievement by IL-6 pathway inhibitor monotherapy. Objectives: To identify predictive factors for clinical and structural remission by tocilizumab without methotrexate in patients with RA. Methods: This is a post hoc analysis of the SURPRISE study, a 2-year randomized, controlled study comparing the efficacy of tocilizumab with (ADD-ON) and without methotrexate (SWITCH) in active RA patients despite methotrexate therapy. The primary endpoint was the DAS28-ESR remission ( Results: In SWITCH (n = 96), CRP, SAA, RF and DAS28 at baseline showed predictive value for DAS28 remission at week 24 in univariate analysis. Multivariate analysis confirmed SAA, RF and DAS28 at baseline, but not CRP, as predictive factors, with SAA having the highest value (OR [95%CI] by decrease of 5.0 μg/mL = 1.011 [1.002-1.020], p = 0.01, ROC-AUC = 0.731). SAA of Conclusion: SAA levels at baseline can predict the necessity of concomitant methotrexate in tocilizumab initiation in patients with RA. Patients with low levels of SAA at baseline may benefit similarly from tocilizumab therapy with and without methotrexate in terms of achieving clinical and structural remission. Reference: [1] Kaneko Y, et al. Ann Rheum Dis. 2016 Nov;75(11):1917-1923. Kaneko Y, et al. Ann Rheum Dis. 2018 Sep;77(9):1268-1275. Disclosure of Interests: : Masaru Kato Grant/research support from: GSK, Actelion, Speakers bureau: GSK, Actelion, Bayer, Nippon Shinyaku, Eli Lilly, Chugai, Pfizer, Ayumi, Eisai, Asahi Kasei, Yuko Kaneko Grant/research support from: Abbvie, Eisai, Speakers bureau: AbbVie, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Jansen, Kissei, Pfizer, Sanofi, Takeda, Tanabe-Mitsubishi, UCB, Yoshiya Tanaka Grant/research support from: Abbvie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, MSD, Ono, Taisho-Toyama, Takeda, Speakers bureau: Abbvie, Asahi-kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eli Lilly, Eisai, Glaxo-Smithkline, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer Japan Inc, Sanofi, Takeda, UCB, YL Biologics, Masayuki Inoo: None declared, Hitomi Kobayashi-Haraoka: None declared, Koichi Amano Grant/research support from: Asahi Kasei Pharma, Chugai Pharmaceutical Co. Ltd., Speakers bureau: AbbVie GK, Eli Lilly Japan K.K., Mitsubishi Tanabe Pharma, Pfizer Japan Inc., Masayuki Miyata: None declared, Yohko Murakawa Grant/research support from: Asahi Kasei Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Teijin Pharma Ltd., Eisai Co., Ltd., Nippon Kayaku Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Paid instructor for: Kissei Pharmaceutical Co., Ltd., Janssen Pharmaceutical K.K. Eisai Co., Ltd., Speakers bureau: Ono Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Astellas Pharma Inc., UCB Japan Co. Ltd., Chugai Pharmaceutical Co., Ltd., AbbVie GK, Daiichi Sankyo Co., Ltd., AYUMI Pharmaceutical Corporation, Janssen Pharmaceutical K.K., Takeda Pharmaceutical Company Limited, Sanofi K.K. Teijin Pharma Ltd., Eli Lilly Japan K.K., Eisai Co., Ltd., Hidekata Yasuoka: None declared, Shintaro Hirata Grant/research support from: Eli Lilly, UCB, Consultant for: Bristol-Myers Squibb, Jansen, UCB, Paid instructor for: AbbVie, Eisai, Tanabe-Mitsubishi, Speakers bureau: AbbVie, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Jansen, Kissei, Pfizer, Sanofi, Takeda, Tanabe-Mitsubishi, UCB, Hayato Nagasawa: None declared, Eiichi Tanaka Speakers bureau: Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Nobuyuki Miyasaka: None declared, Hisashi Yamanaka Grant/research support from: AbbVie, Eisai, Bristol-Meyers, Novartis, Behringer, Astellas, Kaken, Nippon-Shinyaku, Pfizer, UCB, Ayumi, Ono, Daiichi-Sankyo, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Chugai, Teijin Pharma, Torii, YLbio, Speakers bureau: Bristol-Meyers, Astellas, Pfizer, Daiichi-Sankyo, Takeda, Tanabe-Mitsubishi, Chugai, Teijin Pharma, YLbio, Kazuhiko Yamamoto Grant/research support from: Astellas, BMS, Daiichi-Sankyo, Mitsubishi Tanabe, Pfizer, Ayumi, Takeda, Chugai, Eisai, Taisho Toyama, UCB, Janssen, Eli Lilly, and NIPPON KAYAKU., Speakers bureau: Astellas, BMS, Daiichi-Sankyo, Mitsubishi Tanabe, Pfizer, Ayumi, Takeda, Chugai, Eisai, Taisho Toyama, UCB, Janssen, Eli Lilly, and NIPPON KAYAKU., Isao Yokota Speakers bureau: Chugai Pharma, Tatsuya Atsumi Grant/rese ...