Key clinical point: A combination of tocilizumab and methotrexate was more effective than tocilizumab alone for preventing progression in adults with rheumatoid arthritis (RA) overall, but no significant difference was noted in patients with early RA and more joint damage or in those with lower baseline DAS28 scores. In addition, established patients with longer disease duration at baseline did not fare better on combination therapy vs. monotherapy.

Major finding: The relative risks of radiographic progression in subgroups of RA patients on tocilizumab monotherapy vs. combination tocilizumab and methotrexate were not significantly different. Relative risks for patients with early RA and more joint damage, patients with early RA and lower baseline DAS28 scores, and established patients with longer disease duration at baseline were RR 1.02 vs. 0.91, RR 1.04 vs. 0.92, and 1.04 vs. 0.83, respectively, for the combination vs. monotherapy.

Study details: The data come from a review of four randomized trials that compared tocilizumab monotherapy to a combination of tocilizumab and methotrexate and included a total of 820 adults with RA; the main outcome was lack of radiographic progression after 2 years.

Disclosures: The study received no outside funding. Trial data were made available at no charge by F. Hoffmann-La Roche. Two authors reported financial ties to F. Hoffmann-La Roche, and one author is an employee of Roche Nederland B.V.