Subcutaneous Tocilizumab in Monotherapy or in Combination With Nonbiologic Disease-Modifying Antirheumatic Drugs in Latin American Patients With Moderate to Severe Active Rheumatoid Arthritis: A Multicenter, Phase IIIb Study

Dual-Drug Loaded Separable Microneedles for Efficient Rheumatoid Arthritis Therapy

Although the inhibitors of the interleukin-6 receptor (IL-6R) and tumor necrosis factor-α (TNF-α) have achieved a certain success in the clinical treatment of rheumatoid arthritis (RA), great effort should be made to overcome side effects and to improve patient compliance. The present research aimed to address these problems by the co-delivery of tocilizumab (TCZ)—an inhibitor of IL-6R—and an aptamer Apt1-67, which specifically inhibits TNF receptor 1 via separable microneedles (MN). MN were featured with a sustained release of TCZ from needle tips and a rapid release of Apt1-67 from needle bodies by using methacrylate groups grafted hyaluronic acid as the fillings of needle tips and polyvinyl alcohol/polyvinyl pyrrolidone as the fillings of needle bodies. Our results demonstrated that TCZ and Apt1-67 were distributed in MN as expected, and they could be released to the surroundings in the skin. In vivo studies revealed that combined medication via MN (TCZ/Apt1-67@MN) was superior to MN loaded with a single drug. Compared with subcutaneous injection, TCZ/Apt1-67@MN was of great advantage in inhibiting bone erosion and alleviating symptoms of CIA mice. This study not only provides a novel approach for combined medication with different release properties but also supplies a strategy for improving drug efficacy.

Real-world evidence on methotrexate-free subcutaneous tocilizumab therapy in patients with rheumatoid arthritis: 24-week data from the SIMPACT study

Objectives

The SIMPACT study aimed to evaluate the efficacy and safety of methotrexate (MTX)-free subcutaneous tocilizumab (TCZ) therapy in rheumatoid arthritis (RA) patients.

Methods

SIMPACT was an open-label, non-controlled, non-randomised, non-interventional study, where RA patients, for whom the treating physicians ordered subcutaneous TCZ, were observed during a 24-week treatment period in Hungarian centres. While the use of methotrexate (MTX) was avoided during the study period, other conventional synthetic disease modifying anti-rheumatoid drugs (DMARDs), oral steroid and non-steroid anti-inflammatory agents were allowed. Study endpoints included the change in Disease Activity Score-28 (DAS28) and Clinical Activity Index (CDAI) scores, the proportion of patients achieving remission in the whole population and in subgroups defined based on prior RA treatment history—and age, weight or gender post-hoc. The extent of supplementary medication use was monitored.

Results

337 RA patients were enrolled in 18 study centres. TCZ therapy significantly decreased the disease activity measured both by DAS28 (p = 0.0001) and CDAI (p = 0.0001). Clinical response was more pronounced in biological-naïve patients, and was lower in patients above 75 years. In the whole population DAS28 ESR or CRP and CDAI remission rates were 70.10%, 78.95% and 33.59%, respectively. Below 45 years CDAI remission rate doubled (67.86%). Significant decrease in the frequency of co-administered medication was reported including oral steroids and DMARDs.

Conclusion

Real-world clinical evidence on subcutaneous TCZ reported here is in-line with the efficacy outcomes of randomised clinical trials (RCTs). Subgroup analysis revealed that TCZ was more effective in biological-naïve and <75 years patients.

Trial registration

ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT02402686

Review of adverse cutaneous reactions of pharmacologic interventions for COVID-19: A guide for the dermatologist

The new coronavirus, severe acute respiratory syndrome coronavirus 2, is associated with a wide variety of cutaneous manifestations. Although new skin manifestations caused by COVID-19 are continuously being described, other cutaneous entities should also be considered in the differential diagnosis, including adverse cutaneous reactions to drugs used in the treatment of COVID-19 infections. The aim of this review is to provide dermatologists with an overview of the cutaneous adverse effects associated with the most frequently prescribed drugs in patients with COVID-19. The skin reactions of antimalarials (chloroquine and hydroxychloroquine), antivirals (lopinavir/ritonavir, ribavirin with or without interferon, oseltamivir, remdesivir, favipiravir, and darunavir), and treatments for complications (imatinib, tocilizumab, anakinra, immunoglobulins, corticosteroids, colchicine and low molecular weight heparins) are analyzed. Information regarding possible skin reactions, their frequency, management, and key points for differential diagnosis are presented.