Tocilizumab vs prednisone in established rheumatoid arthritis patients (TOPIRA): an investigator-initiated randomised clinical trial.

作者：S. Fadaei, M. S. van der Leeuw, S. Linn-Rasker, B. de Klerk, Judith J W Peeters, D. den Uyl, Annelies Maas-de Kok, Reinhard Bos, J. Tekstra, F. Nap, A. C. A. Marijnissen, P. Welsing, J. V. van Laar · 发表于：Rheumatology · 年份：2025 · DOI：10.1093/rheumatology/keaf591 · 被引用次数：1 · 研究领域：Medicine

OBJECTIVES In rheumatoid arthritis (RA) patients with an insufficient response to conventional synthetic DMARDs (csDMARDs), both biological DMARDs and low-to-moderate dose glucocorticoids are effective treatment options. However, direct comparative evidence on their relative effectiveness and safety is lacking. METHODS This investigator-initiated, open-label, randomised trial compared 10 mg daily prednisone to weekly subcutaneous tocilizumab (TCZ, 162 mg), both added to stable csDMARD therapy, in a 12-month treat-to-target strategy. If treatment response was inadequate at 3 months, patients switched to the alternative arm. The primary end point was Clinical Disease Activity Index (CDAI) averaged over months 6-12. Secondary outcomes included the Glucocorticoid Toxicity Index (GTI), TCZ-related adverse events, and radiographic progression. RESULTS Sixty-five patients with established RA were included in the intention-to-treat population. TCZ was superior in reducing CDAI over months 6-12 (mean difference on square root scale: -0.64; 95% CI: -1.18 to - 0.09). Treatment was switched in 28% (TCZ) and 52% (prednisone). No significant differences were observed in toxicity (GTI: p= 0.922; TCZ related-AEs: p= 1.00) or in radiographic progression (p= 0.376). On-treatment analyses yielded similar results. CONCLUSION TCZ led to greater improvement in disease activity than prednisone. There was no significant difference in joint damage progression over 12 months and there were no ma...