TOPLINE:

Tocilizumab demonstrated better efficacy than prednisone in reducing disease activity in patients with active rheumatoid arthritis (RA) over 6-12 months, with both treatments showing comparable adverse events.

METHODOLOGY:

• Researchers conducted an open-label randomised trial including 65 adults with active RA (mean age, 59.1 years; median disease duration, 13 years) across seven hospitals in Netherlands between February 2020 and September 2023 to compare the clinical effectiveness of tocilizumab with that of prednisone.
• Active RA was defined as having a Clinical Disease Activity Index (CDAI) score greater than 10 and at least one swollen joint on the basis of the 28-joint count, while being on a stable conventional synthetic disease-modifying antirheumatic drug (DMARD) treatment for at least 8 weeks.
• Patients were randomly assigned to receive either 162 mg weekly subcutaneous biologic DMARD tocilizumab (n = 32) or 10 mg oral prednisone daily (n = 33), with assessments conducted every month up to 3 months followed by every 3 months.
• Treatment modifications were implemented on the basis of disease activity, with a switch to the alternate treatment arm occurring at 3 months. Tocilizumab or prednisone was tapered in cases of clinical remission (a CDAI score < 2.8 with no swollen joints).
• The primary outcome was the CDAI score assessed over months 6, 9, and 12, and secondary outcomes included adverse events associated with glucocorticoids or tocilizumab and radiographic progression.

TAKEAWAY:

• Tocilizumab showed superior efficacy than prednisone in reducing disease activity over 6-12 months (mean difference on the square root scale, -0.64; 95% CI, -1.18 to -0.09).
• Treatment switching rates differed between the two groups, with 8 of 32 patients in the tocilizumab group switching to prednisone or stopping treatment and 19 of 33 patients in the prednisone group switching to tocilizumab or stopping treatment due to inadequate responses or adverse events.
• No significant differences were noted between the two groups in terms of glucocorticoid toxicity, adverse events, or radiographic progression.

IN PRACTICE:

"Although TCZ [tocilizumab] was found to be more effective in reducing disease activity, both treatments were effective and no differences in joint damage were observed. As such low-medium dose prednisone may be an appropriate low cost alternative to TCZ in patients with an insufficient response to DMARDs, while considering potential long-term side effects," the authors wrote.

SOURCE:

This study was led by Sina Fadaei, UMC Utrecht, Utrecht, Netherlands. It was published online on November 09, 2025, in Rheumatology.

LIMITATIONS:

The sample size of the study was small. The open-label design may have introduced assessment bias.

DISCLOSURES:

This study was funded by F. Hoffmann-La Roche Ltd. One author reported serving on the editorial board of Rheumatology, and another author reported receiving research grants from Boehringer Ingelheim and Alfasigma and honoraria from AbbVie, AstraZeneca, GSK, and other sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.