Tocilizumab Beats Adalimumab in Monotherapy RA Trial

Current standard treatment for rheumatoid arthritis is methotrexate, and data clearly show that if we combine methotrexate and a biologic it is better for the long term. Currently, the message is to follow conventional treatment and add a biologic to methotrexate. We see a trend of better responses to biologics when patients are also on methotrexate. We do not yet have sufficient data to use biologics as monotherapy in routine practice, but we know that about 30% of RA patients take biologics as monotherapy.

Dr. Maxime Dougados

Based on what is known about adalimumab, using it as the comparator anti-TNF drug against tocilizumab was not fair. Nevertheless, it was fair based on worldwide practice. Adalimumab is a very commonly used drug; the choice reflects rheumatology practice. Although adalimumab is about the same as other anti-TNF drugs when used with methotrexate, the trend favors using etanercept (Enbrel) for anti-TNF monotherapy.

The results from the ADACTA trial are clinically relevant and cannot be ignored, but we need additional information before it changes how we routinely treat patients. For the time being, we should continue to consider anti-TNF drugs to be the standard class of biologic drugs for treating RA patients. The new findings are very encouraging for tocilizumab, but we can’t yet change practice based on them.

Maxime Dougados, M.D., is professor of rheumatology at Cochin Hospital in Paris. He said that he has received research support from and has been a consultant to Roche and to several other drug companies. He made these comments in an interview.