DOCTIS

Decision On Optimal Combinatorial Therapies In Immune-Mediated Inflammatory Diseases (IMIDS) Using Systems Approaches.

The goal of treatment in rheumatoid and psoriatic arthritis is disease remission i.e. removing inflammation completely which is important in protecting joints from damage caused by inflammation. One group of biologic medicines call tumour necrosis factor inhibitors is commonly used to treat rheumatoid arthritis and psoriatic arthritis. In many patients, inflammation is reduced but not removed completely. Based on blood samples from patients with rheumatoid and psoriatic arthritis who have been treated with tumour necrosis factor, we have found evidence that another group of biologic medicine, interleukin-6 inhibitors, may remove the remaining inflammation in those individuals who did not achieve remission. The goal of this study is to test whether this is true.

In this study, we will recruit patients with rheumatoid or psoriatic arthritis who are receiving any one of the following inhibitors, etanercept, adalimumab, golimumab, certolizumab or infliximab but still have active inflammation in their joints. Tocilizumab, an interleukin-6 inhibitor which is an approved treatment for rheumatoid arthritis will be added to their current treatment. The initial dose will be half the normal dose. If the patient tolerates treatment without any side effect, after 8 weeks the dose will be escalated to full dose. Treatment will last 24 weeks. The outcome of the study is the percentage of patients who will achieve disease remission. The secondary goal is to determine the tolerability of adding tocilizumab to tumour necrosis factor inhibitors.