Tocilizumab vs. prednisone: Which yields better disease control in established RA?

In the investigator-initiated TOPIRA randomized trial, 65 patients with established rheumatoid arthritis and insufficient response to conventional synthetic DMARDs (csDMARDs) received either weekly SC tocilizumab (162 mg) or daily prednisone (10 mg), both added to stable csDMARDs. Over 12 months, tocilizumab led to greater improvement in disease activity than prednisone (mean difference, –0.64; 95% confidence interval, –1.18 to –0.09). Treatment switching due to inadequate response was more frequent in the prednisone group (52% vs. 28%). No significant differences were observed in glucocorticoid toxicity, tocilizumab-related adverse events, or radiographic progression.

Clinical takeaway: While tocilizumab reduced disease activity more effectively, both treatments were beneficial and joint damage didn’t differ. Low- to medium-dose prednisone may remain a cost-conscious option for patients with inadequate DMARD response, while considering long-term risks.

Source:

Fadaei S, et al. (2025, November 9). Rheumatology (Oxford). Tocilizumab vs prednisone in established rheumatoid arthritis patients (TOPIRA): an investigator-initiated randomised clinical trial. https://pubmed.ncbi.nlm.nih.gov/41206922/