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A Non-Interventional Study Evaluating Rheumatoid Arthritis Participants Treated With Tocilizumab (RoActemra/Actemra)

A Multi-Center, Non-Interventional Study to Evaluate Rheumatoid Arthritis (RA) Patients Treated With Tocilizumab (ACROSS)

Status
Completed
Phases
Unknown
Study type
Observational
Source
ClinicalTrials.gov
Registry ID
NCT01671059
Enrollment
80
Registered
2012-08-23
Start date
2012-07-31
Completion date
2015-09-30
Last updated
2017-02-23

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Rheumatoid Arthritis

Brief summary

This non-interventional study evaluated the use and efficacy of tocilizumab (RoActemra/Actemra) in participants with moderate to severe rheumatoid arthritis. Eligible participants initiated on tocilizumab treatment according to the approved label were followed for 6 months.

Interventions

None listed

Sponsors

Hoffmann-La Roche
Lead SponsorINDUSTRY

Study design

Observational model
COHORT
Time perspective
PROSPECTIVE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Adult participants, \>/= 18 years of age * Moderate to severe rheumatoid arthritis according to the revised (1987) American College of Rheumatology (ACR) criteria * Participants in whom the treating physician made the decision to commence tocilizumab treatment (in accordance with the local label); this could include participants who had received tocilizumab treatment within 8 weeks prior to the enrollment visit

Exclusion criteria

* Participants who had received tocilizumab more than 8 weeks prior to the enrollment visit * Participants who had previously received tocilizumab in a clinical trial or for compassionate use * Treatment with any investigational agent within 4 weeks (or 5 half-lives of the investigational agent, whichever was longer) before starting treatment with tocilizumab * History of autoimmune disease or any joint inflammatory disease other than rheumatoid arthritis

Design outcomes

Primary

MeasureTime frame
Percentage of Participants on Tocilizumab 6 Months After Treatment Initiation6 months

Secondary

MeasureTime frameDescription
Percentage of Participants Receiving Tocilizumab After Failing Disease-Modifying Anti-Rheumatic Drugs (DMARDs)6 months
Percentage of Participants Receiving Tocilizumab After Failing Other Biologic AgentsBaseline
Reasons for Dose Modifications6 months
Percentage of Participants With Dose Interruptions6 months
Percentage of Participants Discontinued From Tocilizumab for Safety Versus Efficacy6 months
Percentage of Participants on Tocilizumab Monotherapy at Study Entry6 months
Disease Activity Score Based on 28-Joint Count (DAS28)6 monthsDAS28 was calculated from the number of swollen joints and tender joints using the 28-joint count, the erythrocyte sedimentation rate (ESR; in millimeters per hour \[mm/hour\]) and global health assessment (participant-rated global assessment of disease activity using 10-mm visual analog assessment \[VAS\]); DAS28 score ranged from 0 to 10, where higher scores correspond to greater disease activity.
Percentage of Participants on Combination Therapy Achieving a Response by European League Against Rheumatism (EULAR) Category6 monthsPercentage of participants achieving a response by EULAR category, including moderate, good, or no response. The DAS28-based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good response: change from baseline \<-1.2 with a DAS28 score ≤3.2; Moderate response: change from baseline \<-1.2 with DAS28 scores \>3.2 to ≤ 5.1 or \>5.1, or a change from baseline \<-0.6 to ≥-1.2 with DAS28 scores ≤3.2 and \>3.2 to ≤5.1; No response: change from baseline \<-0.6 to ≥-1.2 with DAS28 score \>5.1, or a change from baseline ≥-0.6 with DAS28 scores ≤3.2, \>3.2 to ≤ 5.1, or \>5.1.
Percentage of Participants on Monotherapy Achieving a Response by European League Against Rheumatism (EULAR) Category6 monthsPercentage of participants achieving a response by EULAR category, including moderate, good, or no response. The DAS28-based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good response: change from baseline \<-1.2 with a DAS28 score ≤3.2; Moderate response: change from baseline \<-1.2 with DAS28 scores \>3.2 to ≤ 5.1 or \>5.1, or a change from baseline \<-0.6 to ≥-1.2 with DAS28 scores ≤3.2 and \>3.2 to ≤5.1; No response: change from baseline \<-0.6 to ≥-1.2 with DAS28 score \>5.1, or a change from baseline ≥-0.6 with DAS28 scores ≤3.2, \>3.2 to ≤ 5.1, or \>5.1.
Percentage of Participants With Dose Modifications6 months
Clinical Disease Activity Index (CDAI) Score6 monthsClinical Disease Activity Index (CDAI) is an index for measuring disease activity in RA. The index was calculated using the following formula: CDAI = number of swollen joints using the 28-joint count (SJC28) + number of tender joints using the 28-joint count (TJC28) + patient global assessment of disease (PGA) based on 10 centimeter \[cm\] Visual Analog Scale \[VAS\] + physician global assessment of disease (PhGA) based on 10 cm VAS. VAS assessments involved a 10 cm horizontal scale from 0 (no disease activity) to 10 (maximum disease activity). Total CDAI scores range from 0 to 76, with higher scores indicating increased disease activity.
Percentage of Participants With American College of Rheumatology (ACR) Response6 monthsACR response was calculated based on total joint count evaluation and other clinical and laboratory assessments. A positive ACR20 response required at least a 20% improvement (reduction) compared to baseline in swollen joint count (28 joints) and tender joint count (28 joints) and at least 3 of the following 5 assessments: patient's global assessment of pain, participant's global assessment of disease activity (PGH), physician's global assessment of disease activity (PhGH) (all 3 assessed at 0 \[good\] to 100 mm \[worst\] VAS scale); participant assessment of disability measured by the Health Assessment Questionnaire-Disability Index (HAQ-DI) (assessed on a 0 to 3 scale, where higher scores represented higher disease activity); acute phase reactant (CRP or ESR). A reduction in the level of and acute phase reactants was considered an improvement. ACR50 and ACR70 require a 50% and 70% improvement from baseline, respectively.
Percentage of Participants With Adverse Events (AEs), Serious Adverse Events (SAEs), and AEs of Special Interest (AESIs)6 monthsAn AESI includes serious/medically significant infections; opportunistic infections; cases of elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in combination with either elevated bilirubin or clinical jaundice; suspected transmission of an infectious agent by the study drug; myocardial infarction /acute coronary syndrome; gastrointestinal perforations; malignancies; anaphylaxis / hypersensitivity reactions (including injection site reactions); demyelinating disorders; stroke; serious/medically significant bleeding events; or serious/medically significant hepatic events.
Patient Global Assessment of Disease Activity Score6 monthsThe Patient Global Assessment of disease activity provides an overall assessment of how RA affects the participant using a visual analogue score, where 0 indicates they are managing very well and 100 indicates they are managing very poorly. A decrease in the score indicates improvement.
Health Assessment Questionnaire Disability Index (HAQ-DI)6 monthsThe HAQ is a participant self-reported questionnaire for assessing the extent of the participant's functional ability. It consists of 20 questions in 8 categories (dressing and grooming, rising, eating, walking, reach, grip, hygiene, and carrying out daily activities). Each question has 4 response options, ranging from 0=no difficulty; 1=some difficulty; 2=much difficulty; 3=unable to do. The HAQ scale is an average of all the scores and ranges from 0 to 3, where higher scores represent higher disease activity.
Visual Analogue Scale (VAS) for Fatigue6 monthsThe VAS-fatigue provides an overall assessment of the level of fatigue that the participant is experiencing using a visual analogue score, where 0 indicates no fatigue, and 100 indicates extreme fatigue. A decrease in the score indicates improvement.
Visual Analogue Scale (VAS) for Morning Stiffness6 monthsMorning stiffness was defined by the time elapsed between the time of usual awakening (even if not in the morning) and the time the participant was as limber as he/she would be during a day involving typical activities. Morning stiffness was assessed on a 100 mm VAS, where 0= none and 100= very severe.
Visual Analogue Scale (VAS) for Pain6 monthsThe VAS-Pain provides an overall assessment of the severity of pain that the participant is experiencing using a visual analogue score, where 0 indicates no pain and 100 indicates unbearable pain. A decrease in the score indicates improvement.
Simplified Disease Activity Index (SDAI)6 monthsSimplified Disease Activity Index (SDAI) is an index for measuring disease activity in RA and has a good correlation with the DAS28. The index is calculated using the following formula: SDAI: swollen joint count (SJC28) + tender joint count (TJC28) + physician global assessment (PGA) (10 cm visual analogue scale \[VAS\]) + PhGA (10 cm VAS + C-Reactive Protein (CRP) in milligrams/liter (mg/L). VAS assessments involved a 10 cm horizontal scale from 0 (no disease activity) to 10 (maximum disease activity). Scores range from 0 to 86, with higher scores also indicating increased disease activity.

Countries

Serbia

Participant flow

Participants by arm

ArmCount
Tocilizumab
Participants with rheumatoid arthritis (RA) receiving tocilizumab either as combination therapy or monotherapy through routine clinical practice.
80
Total80

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyAdverse Event4
Overall StudyLack of Efficacy1

Baseline characteristics

CharacteristicTocilizumab
Age, Continuous50.6 years
STANDARD_DEVIATION 11.98
Gender
Female
67 Participants
Gender
Male
13 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
11 / 80
serious
Total, serious adverse events
11 / 80

Outcome results

Primary

Percentage of Participants on Tocilizumab 6 Months After Treatment Initiation

Time frame: 6 months

Population: Enrolled participants.

ArmMeasureValue (NUMBER)
TocilizumabPercentage of Participants on Tocilizumab 6 Months After Treatment Initiation93.75 percentage of participants
Secondary

Clinical Disease Activity Index (CDAI) Score

Clinical Disease Activity Index (CDAI) is an index for measuring disease activity in RA. The index was calculated using the following formula: CDAI = number of swollen joints using the 28-joint count (SJC28) + number of tender joints using the 28-joint count (TJC28) + patient global assessment of disease (PGA) based on 10 centimeter \[cm\] Visual Analog Scale \[VAS\] + physician global assessment of disease (PhGA) based on 10 cm VAS. VAS assessments involved a 10 cm horizontal scale from 0 (no disease activity) to 10 (maximum disease activity). Total CDAI scores range from 0 to 76, with higher scores indicating increased disease activity.

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureGroupValue (MEDIAN)
TocilizumabClinical Disease Activity Index (CDAI) ScoreCombination therapy7.05 units on a scale
TocilizumabClinical Disease Activity Index (CDAI) ScoreMonotherapy6 units on a scale
Secondary

Disease Activity Score Based on 28-Joint Count (DAS28)

DAS28 was calculated from the number of swollen joints and tender joints using the 28-joint count, the erythrocyte sedimentation rate (ESR; in millimeters per hour \[mm/hour\]) and global health assessment (participant-rated global assessment of disease activity using 10-mm visual analog assessment \[VAS\]); DAS28 score ranged from 0 to 10, where higher scores correspond to greater disease activity.

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureGroupValue (MEDIAN)
TocilizumabDisease Activity Score Based on 28-Joint Count (DAS28)Combination therapy2.78 units on a scale
TocilizumabDisease Activity Score Based on 28-Joint Count (DAS28)Monotherapy2.45 units on a scale
Secondary

Health Assessment Questionnaire Disability Index (HAQ-DI)

The HAQ is a participant self-reported questionnaire for assessing the extent of the participant's functional ability. It consists of 20 questions in 8 categories (dressing and grooming, rising, eating, walking, reach, grip, hygiene, and carrying out daily activities). Each question has 4 response options, ranging from 0=no difficulty; 1=some difficulty; 2=much difficulty; 3=unable to do. The HAQ scale is an average of all the scores and ranges from 0 to 3, where higher scores represent higher disease activity.

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureGroupValue (MEDIAN)
TocilizumabHealth Assessment Questionnaire Disability Index (HAQ-DI)Combination therapy0.43 units on a scale
TocilizumabHealth Assessment Questionnaire Disability Index (HAQ-DI)Monotherapy0.43 units on a scale
Secondary

Patient Global Assessment of Disease Activity Score

The Patient Global Assessment of disease activity provides an overall assessment of how RA affects the participant using a visual analogue score, where 0 indicates they are managing very well and 100 indicates they are managing very poorly. A decrease in the score indicates improvement.

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureGroupValue (MEDIAN)
TocilizumabPatient Global Assessment of Disease Activity ScoreCombination therapy15 units on a scale
TocilizumabPatient Global Assessment of Disease Activity ScoreMonotherapy14 units on a scale
Secondary

Percentage of Participants Discontinued From Tocilizumab for Safety Versus Efficacy

Time frame: 6 months

Population: Enrolled participants.

ArmMeasureGroupValue (NUMBER)
TocilizumabPercentage of Participants Discontinued From Tocilizumab for Safety Versus EfficacyAdverse Event3 percentage of participants
TocilizumabPercentage of Participants Discontinued From Tocilizumab for Safety Versus EfficacyLack of Efficacy1 percentage of participants
Secondary

Percentage of Participants on Combination Therapy Achieving a Response by European League Against Rheumatism (EULAR) Category

Percentage of participants achieving a response by EULAR category, including moderate, good, or no response. The DAS28-based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good response: change from baseline \<-1.2 with a DAS28 score ≤3.2; Moderate response: change from baseline \<-1.2 with DAS28 scores \>3.2 to ≤ 5.1 or \>5.1, or a change from baseline \<-0.6 to ≥-1.2 with DAS28 scores ≤3.2 and \>3.2 to ≤5.1; No response: change from baseline \<-0.6 to ≥-1.2 with DAS28 score \>5.1, or a change from baseline ≥-0.6 with DAS28 scores ≤3.2, \>3.2 to ≤ 5.1, or \>5.1.

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureGroupValue (NUMBER)
TocilizumabPercentage of Participants on Combination Therapy Achieving a Response by European League Against Rheumatism (EULAR) CategoryModerate response32.1 percentage of participants
TocilizumabPercentage of Participants on Combination Therapy Achieving a Response by European League Against Rheumatism (EULAR) CategoryGood response62.3 percentage of participants
TocilizumabPercentage of Participants on Combination Therapy Achieving a Response by European League Against Rheumatism (EULAR) CategoryNo response5.7 percentage of participants
Secondary

Percentage of Participants on Monotherapy Achieving a Response by European League Against Rheumatism (EULAR) Category

Percentage of participants achieving a response by EULAR category, including moderate, good, or no response. The DAS28-based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good response: change from baseline \<-1.2 with a DAS28 score ≤3.2; Moderate response: change from baseline \<-1.2 with DAS28 scores \>3.2 to ≤ 5.1 or \>5.1, or a change from baseline \<-0.6 to ≥-1.2 with DAS28 scores ≤3.2 and \>3.2 to ≤5.1; No response: change from baseline \<-0.6 to ≥-1.2 with DAS28 score \>5.1, or a change from baseline ≥-0.6 with DAS28 scores ≤3.2, \>3.2 to ≤ 5.1, or \>5.1.

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureGroupValue (NUMBER)
TocilizumabPercentage of Participants on Monotherapy Achieving a Response by European League Against Rheumatism (EULAR) CategoryGood response71.4 percentage of participants
TocilizumabPercentage of Participants on Monotherapy Achieving a Response by European League Against Rheumatism (EULAR) CategoryModerate response28.6 percentage of participants
TocilizumabPercentage of Participants on Monotherapy Achieving a Response by European League Against Rheumatism (EULAR) CategoryNo response0.0 percentage of participants
Secondary

Percentage of Participants on Tocilizumab Monotherapy at Study Entry

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureValue (NUMBER)
TocilizumabPercentage of Participants on Tocilizumab Monotherapy at Study Entry13.6 percentage of participants
Secondary

Percentage of Participants Receiving Tocilizumab After Failing Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureValue (NUMBER)
TocilizumabPercentage of Participants Receiving Tocilizumab After Failing Disease-Modifying Anti-Rheumatic Drugs (DMARDs)81.35 percentage of participants
Secondary

Percentage of Participants Receiving Tocilizumab After Failing Other Biologic Agents

Time frame: Baseline

Population: Enrolled participants.

ArmMeasureValue (NUMBER)
TocilizumabPercentage of Participants Receiving Tocilizumab After Failing Other Biologic Agents18.8 percentage of participants
Secondary

Percentage of Participants With Adverse Events (AEs), Serious Adverse Events (SAEs), and AEs of Special Interest (AESIs)

An AESI includes serious/medically significant infections; opportunistic infections; cases of elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in combination with either elevated bilirubin or clinical jaundice; suspected transmission of an infectious agent by the study drug; myocardial infarction /acute coronary syndrome; gastrointestinal perforations; malignancies; anaphylaxis / hypersensitivity reactions (including injection site reactions); demyelinating disorders; stroke; serious/medically significant bleeding events; or serious/medically significant hepatic events.

Time frame: 6 months

Population: Enrolled participants.

ArmMeasureGroupValue (NUMBER)
TocilizumabPercentage of Participants With Adverse Events (AEs), Serious Adverse Events (SAEs), and AEs of Special Interest (AESIs)AE25 percentage of participants
TocilizumabPercentage of Participants With Adverse Events (AEs), Serious Adverse Events (SAEs), and AEs of Special Interest (AESIs)SAE13.75 percentage of participants
TocilizumabPercentage of Participants With Adverse Events (AEs), Serious Adverse Events (SAEs), and AEs of Special Interest (AESIs)AESI1.25 percentage of participants
Secondary

Percentage of Participants With American College of Rheumatology (ACR) Response

ACR response was calculated based on total joint count evaluation and other clinical and laboratory assessments. A positive ACR20 response required at least a 20% improvement (reduction) compared to baseline in swollen joint count (28 joints) and tender joint count (28 joints) and at least 3 of the following 5 assessments: patient's global assessment of pain, participant's global assessment of disease activity (PGH), physician's global assessment of disease activity (PhGH) (all 3 assessed at 0 \[good\] to 100 mm \[worst\] VAS scale); participant assessment of disability measured by the Health Assessment Questionnaire-Disability Index (HAQ-DI) (assessed on a 0 to 3 scale, where higher scores represented higher disease activity); acute phase reactant (CRP or ESR). A reduction in the level of and acute phase reactants was considered an improvement. ACR50 and ACR70 require a 50% and 70% improvement from baseline, respectively.

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureGroupValue (NUMBER)
TocilizumabPercentage of Participants With American College of Rheumatology (ACR) ResponseACR70 Response: Monotherapy33.3 percentage of participants
TocilizumabPercentage of Participants With American College of Rheumatology (ACR) ResponseACR20 Response: Combination therapy87.8 percentage of participants
TocilizumabPercentage of Participants With American College of Rheumatology (ACR) ResponseACR20 Response: Monotherapy100 percentage of participants
TocilizumabPercentage of Participants With American College of Rheumatology (ACR) ResponseACR50 Response: Combination therapy46.3 percentage of participants
TocilizumabPercentage of Participants With American College of Rheumatology (ACR) ResponseACR50 Response: Monotherapy66.6 percentage of participants
TocilizumabPercentage of Participants With American College of Rheumatology (ACR) ResponseACR70 Response: Combination therapy41.4 percentage of participants
Secondary

Percentage of Participants With Dose Interruptions

Time frame: 6 months

Population: Enrolled participants.

ArmMeasureValue (NUMBER)
TocilizumabPercentage of Participants With Dose Interruptions3.75 percentage of participants
Secondary

Percentage of Participants With Dose Modifications

Time frame: 6 months

Population: Enrolled participants.

ArmMeasureValue (NUMBER)
TocilizumabPercentage of Participants With Dose Modifications11.2 percentage of participants
Secondary

Reasons for Dose Modifications

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureGroupValue (NUMBER)
TocilizumabReasons for Dose ModificationsLow level of neutrophils1 participants
TocilizumabReasons for Dose ModificationsAdverse event3 participants
TocilizumabReasons for Dose ModificationsOther reason1 participants
TocilizumabReasons for Dose ModificationsMissing data1 participants
TocilizumabReasons for Dose ModificationsUnknown reason3 participants
Secondary

Simplified Disease Activity Index (SDAI)

Simplified Disease Activity Index (SDAI) is an index for measuring disease activity in RA and has a good correlation with the DAS28. The index is calculated using the following formula: SDAI: swollen joint count (SJC28) + tender joint count (TJC28) + physician global assessment (PGA) (10 cm visual analogue scale \[VAS\]) + PhGA (10 cm VAS + C-Reactive Protein (CRP) in milligrams/liter (mg/L). VAS assessments involved a 10 cm horizontal scale from 0 (no disease activity) to 10 (maximum disease activity). Scores range from 0 to 86, with higher scores also indicating increased disease activity.

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureGroupValue (MEDIAN)
TocilizumabSimplified Disease Activity Index (SDAI)Combination therapy6.69 units on a scale
TocilizumabSimplified Disease Activity Index (SDAI)Monotherapy4.5 units on a scale
Secondary

Visual Analogue Scale (VAS) for Fatigue

The VAS-fatigue provides an overall assessment of the level of fatigue that the participant is experiencing using a visual analogue score, where 0 indicates no fatigue, and 100 indicates extreme fatigue. A decrease in the score indicates improvement.

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureGroupValue (MEDIAN)
TocilizumabVisual Analogue Scale (VAS) for FatigueCombination therapy15 units on a scale
TocilizumabVisual Analogue Scale (VAS) for FatigueMonotherapy11 units on a scale
Secondary

Visual Analogue Scale (VAS) for Morning Stiffness

Morning stiffness was defined by the time elapsed between the time of usual awakening (even if not in the morning) and the time the participant was as limber as he/she would be during a day involving typical activities. Morning stiffness was assessed on a 100 mm VAS, where 0= none and 100= very severe.

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureGroupValue (MEDIAN)
TocilizumabVisual Analogue Scale (VAS) for Morning StiffnessCombination therapy10 units on a scale
TocilizumabVisual Analogue Scale (VAS) for Morning StiffnessMonotherapy12 units on a scale
Secondary

Visual Analogue Scale (VAS) for Pain

The VAS-Pain provides an overall assessment of the severity of pain that the participant is experiencing using a visual analogue score, where 0 indicates no pain and 100 indicates unbearable pain. A decrease in the score indicates improvement.

Time frame: 6 months

Population: Enrolled participants who were evaluable for this outcome measure.

ArmMeasureGroupValue (MEDIAN)
TocilizumabVisual Analogue Scale (VAS) for PainCombination therapy20 units on a scale
TocilizumabVisual Analogue Scale (VAS) for PainMonotherapy20 units on a scale

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026