Efficacy of tocilizumab on disease activity and psychological state in patients with refractory rheum-atoid arthritis

Objective To observe the efficacy and safety of tocilizumab on patients with refractory rheumatoid arthritis (RA). Methods Eighteen RA patients who were refractory to disease-modifying antirheu-matic drugs (DMARDs) or tumor necrosis factor-α (TNF-α) antagonist were treated with tocilizumab were included into this study. Their clinical disease activity indices, Hospital Anxiety and Depression Scale (HADS) and safety were evaluated regularly. Statistical analysis was conducted with Mann-Whitney U test and χ2 test. Results According to clinical disease activity index, 44% (8/18) of patients reached treatment target 2 weeks after the first infusion of tocilizumab, and 78% (14/18) reached treatment target after three infusions of tocilizumab. Fifty-six percent(10/18) of patients had anxiety and 22% (4/18) had depressive symptoms at baseline. After three infusions of tocilizumab, 6% (1/18) had anxiety symptoms and 11% (2/18) had depressive symptoms. The adverse effects included upper respiratory tract infection, aminotransferase elevation and neutropenia (3 patients, respectively). Conclusion Tocilizumab can rapidly and significantly improve the disease activity and psychological state with good tolerance and safety, which can be applied to Chinese refractory RA patients who failed with DMARDs or TNF-α antagonist. Key words: Arthritis, rheumatoid; Tocilizumab; Disease activity; Psychological state; Safety