Efficacy and safety of sarilumab in combination with csDMARDs or as monotherapy in subpopulations of patients with moderately to severely active rheumatoid arthritis in three phase III randomized, controlled studies. Arthritis research & therapy Genovese, M. C., Fleischmann, R., Kivitz, A., Lee, E., van Hoogstraten, H., Kimura, T., St John, G., Mangan, E. K., Burmester, G. R. 2020; 22 (1): 139


BACKGROUND: The interleukin-6 receptor inhibitor sarilumab demonstrated efficacy in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or as monotherapy in patients with moderately to severely active rheumatoid arthritis (RA) with an inadequate response (IR) or intolerant (INT) to methotrexate (MTX) or tumour necrosis factor (TNF)-alpha inhibitors. This analysis investigated the efficacy and safety of sarilumab in patient subgroups.METHODS: Data were included from phase III studies: two placebo-controlled studies of subcutaneous sarilumab 150/200mg every 2weeks (q2w) either + MTX in MTX-IR patients (52weeks) or + csDMARDs in TNF-IR/INT patients (24weeks), and a monotherapy study of sarilumab 200mg q2w vs. adalimumab 40mg q2w in MTX-IR/INT patients (24weeks). Prespecified and post hoc subgroups included patient demographics, disease characteristics, and prior treatments. Prespecified and post hoc endpoints included clinical, radiographic, and physical function measures, and p values are considered nominal. Safety was assessed during double-blind treatment.RESULTS: The superiority of sarilumab (either as monotherapy vs. adalimumab or in combination with csDMARDs vs. placebo+csDMARDs) across clinical endpoints was generally consistent across subgroups defined by patient demographics, disease characteristics, and prior treatments, demonstrating the benefit of sarilumab treatment for a wide range of patient types. Interaction p values of <0.05 were consistently observed across studies only for baseline anti-cyclic citrullinated peptide antibody (ACPA) status for American College of Rheumatology 20% response, but not American College of Rheumatology 50% or 70% response. Adverse events and worsening laboratory parameters occurred more frequently in sarilumab-treated vs. placebo-treated patients and were more frequent in the small number of patients =65years (n=289) vs. patients <65years (n=1819). Serious infections occurred in six patients aged =65years receiving sarilumab, although the incidence of serious infections was generally higher in patients aged =65years regardless of treatment.CONCLUSIONS: Apart from ACPA status, there were no consistent signals indicating differential effects of sarilumab in any of the subpopulations assessed. Sarilumab demonstrated consistent efficacy and safety across a wide range of patients with RA.TRIAL REGISTRATION: ClinicalTrials.gov NCT01061736, registered on February 03, 2010; ClinicalTrials.gov NCT01709578, registered on October 18, 2012; ClinicalTrials.gov NCT02332590, registered on January 07, 2015.

View details for DOI 10.1186/s13075-020-02194-z

View details for PubMedID 32522251