{"id":"https://openalex.org/W7204568092","doi":"https://doi.org/10.64898/2026.08.27.26361508","title":"Real-World Effectiveness and Safety of Tocilizumab in Refractory Rheumatoid Arthritis: A Retrospective Single-Centre Cohort Study of 44 Patients in Morocco","display_name":"Real-World Effectiveness and Safety of Tocilizumab in Refractory Rheumatoid Arthritis: A Retrospective Single-Centre Cohort Study of 44 Patients in Morocco","publication_year":2026,"publication_date":"2026-08-28","ids":{"openalex":"https://openalex.org/W7204568092","doi":"https://doi.org/10.64898/2026.08.27.26361508"},"language":"en","primary_location":{"id":"doi:10.64898/2026.08.27.26361508","doi":"https://doi.org/10.64898/2026.08.27.26361508","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.08.27.26361508","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/08/28/2026.08.27.26361508.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/08/28/2026.08.27.26361508.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5113563841","display_name":"Najoua Ghani","orcid":"https://orcid.org/0009-0005-2195-7877","observed_orcids":["https://orcid.org/0009-0005-2195-7877"]},"institutions":[{"id":"https://openalex.org/I4210139255","display_name":"Euro-Mediterranean University of Fes","ror":"https://ror.org/03s9x8b85","country_code":"MA","type":"education","lineage":["https://openalex.org/I4210139255"]}],"countries":["MA"],"is_corresponding":true,"raw_author_name":"Najoua Ghani","raw_affiliation_strings":["Faculty of Medicine, Euromed University of Fez, Morocco"],"raw_orcid":"https://orcid.org/0009-0005-2195-7877","affiliations":[{"raw_affiliation_string":"Faculty of Medicine, Euromed University of Fez, Morocco","institution_ids":["https://openalex.org/I4210139255"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5113563841"],"corresponding_institution_ids":["https://openalex.org/I4210139255"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10200","display_name":"Rheumatoid Arthritis Research and Therapies","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10200","display_name":"Rheumatoid Arthritis Research and Therapies","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11616","display_name":"Autoimmune and Inflammatory Disorders Research","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2720","display_name":"Hematology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12255","display_name":"Biosimilars and Bioanalytical Methods","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2403","display_name":"Immunology"},"field":{"id":"https://openalex.org/fields/24","display_name":"Immunology and Microbiology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/tocilizumab","display_name":"tocilizumab","score":0.9940000176429749},{"id":"https://openalex.org/keywords/refractory-rheumatoid-arthritis","display_name":"refractory rheumatoid arthritis","score":0.9200000166893005},{"id":"https://openalex.org/keywords/il-6-receptor-inhibition","display_name":"IL-6 receptor inhibition","score":0.8450000286102295},{"id":"https://openalex.org/keywords/real-world-effectiveness","display_name":"real-world effectiveness","score":0.7900000214576721},{"id":"https://openalex.org/keywords/drug-safety","display_name":"drug safety","score":0.8709999918937683},{"id":"https://openalex.org/keywords/eular-response","display_name":"EULAR response","score":0.8420000076293945},{"id":"https://openalex.org/keywords/adverse-events","display_name":"adverse events","score":0.45100000500679016},{"id":"https://openalex.org/keywords/neutropenia","display_name":"neutropenia","score":0.6859999895095825},{"id":"https://openalex.org/keywords/infection","display_name":"infection","score":0.4830000102519989},{"id":"https://openalex.org/keywords/liver-enzymes","display_name":"liver enzymes","score":0.44699999690055847},{"id":"https://openalex.org/keywords/lipid-metabolism-disorders","display_name":"lipid metabolism disorders","score":0.8859999775886536},{"id":"https://openalex.org/keywords/predictors-of-treatment-response","display_name":"predictors of treatment response","score":0.6940000057220459},{"id":"https://openalex.org/keywords/north-african-patients","display_name":"North African patients","score":0.5059999823570251},{"id":"https://openalex.org/keywords/morocco","display_name":"Morocco","score":0.7799999713897705},{"id":"https://openalex.org/keywords/routine-clinical-practice","display_name":"routine clinical practice","score":0.38999998569488525}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9550999999046326},{"id":"https://openalex.org/C2777178219","wikidata":"https://www.wikidata.org/wiki/Q425154","display_name":"Tocilizumab","level":3,"score":0.9003999829292297},{"id":"https://openalex.org/C2777575956","wikidata":"https://www.wikidata.org/wiki/Q187255","display_name":"Rheumatoid arthritis","level":2,"score":0.751800000667572},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.6963000297546387},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.5954999923706055},{"id":"https://openalex.org/C198451711","wikidata":"https://www.wikidata.org/wiki/Q327657","display_name":"Rheumatology","level":2,"score":0.521399974822998},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.5167999863624573},{"id":"https://openalex.org/C195910791","wikidata":"https://www.wikidata.org/wiki/Q1324077","display_name":"Medical record","level":2,"score":0.4871000051498413},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.47690001130104065},{"id":"https://openalex.org/C197934379","wikidata":"https://www.wikidata.org/wiki/Q2047938","display_name":"Adverse effect","level":2,"score":0.42410001158714294},{"id":"https://openalex.org/C142424586","wikidata":"https://www.wikidata.org/wiki/Q7307572","display_name":"Refractory (planetary science)","level":2,"score":0.3905999958515167},{"id":"https://openalex.org/C2781290027","wikidata":"https://www.wikidata.org/wiki/Q413879","display_name":"Golimumab","level":4,"score":0.3882000148296356},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.3255999982357025},{"id":"https://openalex.org/C2780132546","wikidata":"https://www.wikidata.org/wiki/Q348260","display_name":"Adalimumab","level":3,"score":0.3172000050544739},{"id":"https://openalex.org/C2777226972","wikidata":"https://www.wikidata.org/wiki/Q415343","display_name":"Etanercept","level":3,"score":0.31529998779296875},{"id":"https://openalex.org/C2777138892","wikidata":"https://www.wikidata.org/wiki/Q415264","display_name":"Infliximab","level":3,"score":0.3091000020503998},{"id":"https://openalex.org/C2777077863","wikidata":"https://www.wikidata.org/wiki/Q170990","display_name":"Arthritis","level":2,"score":0.3068999946117401},{"id":"https://openalex.org/C2908564923","wikidata":"https://www.wikidata.org/wiki/Q810254","display_name":"Antirheumatic drugs","level":4,"score":0.30329999327659607},{"id":"https://openalex.org/C3018060332","wikidata":"https://www.wikidata.org/wiki/Q10871684","display_name":"Electronic medical record","level":2,"score":0.2989000082015991},{"id":"https://openalex.org/C2776232647","wikidata":"https://www.wikidata.org/wiki/Q702883","display_name":"Rheumatoid factor","level":3,"score":0.29269999265670776},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.29249998927116394},{"id":"https://openalex.org/C2909063479","wikidata":"https://www.wikidata.org/wiki/Q810254","display_name":"Antirheumatic Agents","level":3,"score":0.289000004529953},{"id":"https://openalex.org/C107130276","wikidata":"https://www.wikidata.org/wiki/Q133805","display_name":"Epidemiology","level":2,"score":0.275299996137619},{"id":"https://openalex.org/C2779244835","wikidata":"https://www.wikidata.org/wiki/Q538432","display_name":"Synovitis","level":3,"score":0.26660001277923584}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.08.27.26361508","doi":"https://doi.org/10.64898/2026.08.27.26361508","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.08.27.26361508","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/08/28/2026.08.27.26361508.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.08.27.26361508","doi":"https://doi.org/10.64898/2026.08.27.26361508","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.08.27.26361508","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/08/28/2026.08.27.26361508.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"score":1.0,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7204568092.pdf","grobid_xml":"https://content.openalex.org/works/W7204568092.grobid-xml"},"referenced_works_count":15,"referenced_works":["https://openalex.org/W2009481513","https://openalex.org/W2102207725","https://openalex.org/W2114308202","https://openalex.org/W2133076005","https://openalex.org/W2150952126","https://openalex.org/W2802379102","https://openalex.org/W2803973097","https://openalex.org/W3052031423","https://openalex.org/W3180195397","https://openalex.org/W3195215767","https://openalex.org/W4232642069","https://openalex.org/W4307228818","https://openalex.org/W4309858671","https://openalex.org/W4313857553","https://openalex.org/W7135041886"],"related_works":["https://openalex.org/W2409452102","https://openalex.org/W41715768","https://openalex.org/W2317949227","https://openalex.org/W4414408499","https://openalex.org/W2418423092","https://openalex.org/W2783716243","https://openalex.org/W2553255113","https://openalex.org/W7163921659","https://openalex.org/W2553968455","https://openalex.org/W4312129003"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"Tocilizumab":[2],"(TCZ),":[3],"a":[4,65,108,185,195,205,248,254,313,319,383,393,402,424,433,452],"monoclonal":[5],"antibody":[6],"directed":[7],"against":[8],"the":[9,45,86,117,152,286,372,378,474],"interleukin-6":[10],"receptor,":[11],"is":[12],"used":[13],"in":[14,51,85,173,232,265,331,429],"rheumatoid":[15],"arthritis":[16],"(RA)":[17],"after":[18],"inadequate":[19],"response":[20,25,125,256,380],"or":[21,225],"secondary":[22],"loss":[23],"of":[24,49,70,88,120,188,199,207,455,467],"to":[26,275,293,346,358,366],"conventional":[27,210],"synthetic":[28],"and":[29,47,54,82,99,144,156,165,194,212,257,280,285,316,361,426,432,446,465,473],"biological":[30,221],"disease-modifying":[31],"antirheumatic":[32],"drugs":[33],"(DMARDs).":[34],"Real-world":[35],"data":[36,101,239],"from":[37,104,271,291,344,356,364],"North":[38],"African":[39],"cohorts":[40],"remain":[41],"scarce.":[42],"We":[43,63],"assessed":[44],"effectiveness":[46,114],"safety":[48,435],"TCZ":[50,78,420],"routine":[52],"care":[53],"explored":[55],"baseline":[56,159,274,374,384,444],"factors":[57],"associated":[58,376,391,422,450],"with":[59,74,77,151,170,184,335,377,392,423,438,451],"6-month":[60,166,461],"outcomes.":[61],"Methods":[62],"conducted":[64],"retrospective,":[66],"single-centre":[67],"cohort":[68,179],"study":[69],"44":[71],"consecutive":[72],"patients":[73,310,333],"RA":[75,197,418],"treated":[76],"between":[79,158],"April":[80],"2019":[81],"January":[83],"2024":[84],"Department":[87],"Rheumatology,":[89],"Moulay":[90],"Ismail":[91],"Hospital,":[92],"Meknes,":[93],"Morocco.":[94],"Demographic,":[95],"clinical,":[96],"laboratory,":[97],"treatment":[98],"follow-up":[100],"were":[102,149,168,240,264,299],"extracted":[103],"medical":[105],"records":[106],"using":[107],"standardised":[109],"electronic":[110],"form.":[111],"The":[112,178,457],"primary":[113],"outcome":[115,238],"was":[116,131,371,390,421,449],"European":[118],"Alliance":[119],"Associations":[121],"for":[122,242,322],"Rheumatology":[123],"(EULAR)":[124],"at":[126,162,217,273,277,282,349],"6":[127,236,252,278],"months;":[128],"DAS28-ESR":[129,134,266,269],"remission":[130,395],"defined":[132],"as":[133,399,480],"below":[135,328,338],"2.6.":[136],"Safety":[137],"outcomes":[138,167],"comprised":[139,180],"infections,":[140],"neutropenia,":[141],"liver-enzyme":[142],"abnormalities":[143],"lipid":[145],"abnormalities.":[146],"Longitudinal":[147],"changes":[148],"compared":[150],"Wilcoxon":[153],"signed-rank":[154],"test,":[155],"associations":[157,476],"variables":[160],"dichotomised":[161],"their":[163],"median":[164,186],"examined":[169],"chi-square":[171],"tests,":[172],"SPSS":[174],"version":[175],"29.":[176],"Results":[177],"33":[181],"women":[182],"(75.0%),":[183],"age":[187],"57":[189],"years":[190],"(range":[191],"32\u2013":[192],"82)":[193],"mean":[196,206,287,341],"duration":[198],"12.97\u00b19.1":[200],"years.":[201],"Patients":[202],"had":[203,215,312],"received":[204,216],"2.5\u00b11.8":[208],"previous":[209,220],"DMARDs,":[211],"41":[213],"(93.2%)":[214],"least":[218],"one":[219,302],"agent,":[222],"including":[223,301],"two":[224],"more":[226],"tumour":[227],"necrosis":[228],"factor":[229],"(TNF)":[230],"inhibitors":[231],"36":[233],"(81.8%).":[234],"At":[235],"months,":[237,284],"available":[241],"34":[243],"patients:":[244],"23":[245],"(67.6%)":[246],"achieved":[247],"good":[249],"EULAR":[250,379],"response,":[251],"(17.6%)":[253],"moderate":[255],"5":[258,294,309],"(14.7%)":[259],"no":[260,336],"response;":[261],"12":[262,283,350],"(35.3%)":[263],"remission.":[267,456],"Mean":[268,352],"fell":[270,290],"5.10\u00b11.18":[272],"2.74\u00b11.38":[276],"months":[279],"2.45\u00b11.33":[281],"prednisone-equivalent":[288],"dose":[289],"8.3\u00b17.1":[292],"mg/day.":[295],"Twenty-two":[296],"infectious":[297],"episodes":[298],"recorded,":[300],"serious":[303],"infection":[304],"(purulent":[305],"pleurisy)":[306],"requiring":[307],"hospitalisation;":[308],"(11.4%)":[311],"temporary":[314],"interruption":[315],"1":[317],"(2.3%)":[318],"permanent":[320],"discontinuation":[321],"hepatic":[323],"cytolysis.":[324],"A":[325,442],"neutrophil":[326],"count":[327,337,387],"1,500/mm\u00b3":[329],"occurred":[330],"13":[332],"(29.5%),":[334],"1,000/mm\u00b3,":[339],"while":[340],"neutrophils":[342],"declined":[343],"6.3\u00b13.0":[345],"2.6\u00b11.2":[347],"G/L":[348],"months.":[351],"LDL":[353],"cholesterol":[354,363],"rose":[355],"1.18":[357],"1.49":[359],"g/L":[360],"HDL":[362],"0.58":[365],"0.82":[367],"g/L.":[368],"Rheumatoid-factor":[369],"positivity":[370],"only":[373],"variable":[375],"category":[381],"(p=0.007);":[382],"tender":[385],"joint":[386],"above":[388,407],"six":[389],"lower":[394,453],"rate":[396],"(23.5%,":[397],"p=0.007),":[398],"was,":[400],"borderline,":[401],"pain":[403,447],"visual":[404],"analogue":[405],"scale":[406],"65":[408],"mm":[409],"(31.2%,":[410],"p=0.05).":[411],"Conclusions":[412],"In":[413],"this":[414],"heavily":[415],"pretreated":[416],"real-world":[417],"cohort,":[419],"substantial":[425],"sustained":[427],"reduction":[428],"disease":[430],"activity":[431],"manageable":[434],"profile":[436],"consistent":[437],"its":[439],"known":[440],"signals.":[441],"high":[443],"articular":[445],"burden":[448],"probability":[454],"small":[458],"sample,":[459],"incomplete":[460],"follow-up,":[462],"retrospective":[463],"design":[464],"absence":[466],"adjusted":[468],"effect":[469],"estimates":[470],"limit":[471],"interpretation,":[472],"reported":[475],"should":[477],"be":[478],"regarded":[479],"hypothesis-generating.":[481]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-08-29T00:00:00"}