Concomitant administration of tacrolimus and biological DMARDS, a potential rescue therapy in rheumatoid arthritis

Tacrolimus administered along with biological disease-modifying anti-rheumatic drugs (bDMARDs) showed elevated retention rates compared to bDMARDs therapy without tacrolimus (TAC) or methotrexate (MTX), according to a study published in Modern Rheumatology.

The study considered 2792 patients who received five bDMARDs namely etanercept (ETN), adalimumab (ADA), golimumab (GLM), tocilizumab (TCZ), and abatacept (ABT). Among these subjects, 1582 and 147 patients received concomitant MTX and TAC respectively. Whereas 1063 were non-concomitant to MTX/TAC. The most frequent reasons noted for discontinuation of bDMARDs were loss of efficacy and adverse events (AEs) and analysis revealed a significant decrease in hazards ratio (AEs: HR=0.39, 95 % confidence interval [CI], 0.23–0.68, loss of efficacy: HR=0.49, 95 % CI, 0.30–0.78) in TAC group compared to non-MTX/TAC group.

Kenya Terabe and co-researchers showed that the retention rates were significantly higher in the group that received concomitant TAC with ABT or ETN compared to non-MTX/TAC group. Moreover, concomitant TAC administration did not increase the risk for discontinuation due to adverse events in all bDMARDs analyses.

Several studies have corroborated that TAC add-on therapy concomitant with bDMARDs is effective to manage patients who demonstrated inadequate response to bDMARDs. The present study is one of its kind investigating concomitant administration of TAC with each bDMARDs, among patients who were treated without concomitant MTX. The present findings have suggested that TAC, similar to MTX, may be more effective as concomitant therapy with biological DMARDs.

Reference: Terabe K, Takahashi N, Asai S, Hirano Y, Kanayama Y, Yabe Y, Oguchi T, Fujibayashi T, Ishikawa H, Hanabayashi M, Hattori Y, Suzuki M, Kishimoto K, Ohashi Y, Imaizumi T, Imagama S, Kojima T. Effectiveness of Tacrolimus Concomitant with Biological Disease-Modifying Anti-Rheumatic Drugs in Patients with Rheumatoid Arthritis. Mod Rheumatol. 2022 Mar 15:roac025.