Javier Loricera1, Ricardo Blanco1, José L Hernández1, Santos Castañeda2, Antonio Mera3, Eva Pérez-Pampín3, Enriqueta Peiró1, Alicia Humbría2, Jaime Calvo-Alén4, Elena Aurrecoechea4, Javier Narváez5, Amalia Sánchez-Andrade6, Paloma Vela7, Elvira Díez8, Cristina Mata9, Pau Lluch10, Concepción Moll10, Íñigo Hernández11, Vanesa Calvo-Río1, Francisco Ortiz-Sanjuán1, Carmen González-Vela1, Trinitario Pina1, Miguel Á González-Gay12. 1. Department of Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda. Valdecilla s/n., Santander, Spain. 2. Department of Rheumatology, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain. 3. Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain. 4. Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Spain. 5. Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain. 6. Department of Rheumatology, Hospital Universitario Lucus Augusti, Lugo, Spain. 7. Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain. 8. Department of Rheumatology, Complejo Asistencial Universitario de León, León, España. 9. Department of Rheumatology, Hospital de Laredo, Laredo, Spain. 10. Department of Rheumatology, Hospital Mateu Orfila, Menorca, Spain. 11. Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain. 12. Department of Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda. Valdecilla s/n., Santander, Spain. Electronic address: miguelaggay@hotmail.com.
Abstract
OBJECTIVE: To assess the efficacy of tocilizumab (TCZ) in giant cell arteritis (GCA) patients with refractory disease and/or with unacceptable side effects due to corticosteroids. METHODS: A retrospective multicenter open-label study on 22 GCA patients treated with TCZ at standard dose of 8mg/kg/month. The main outcomes were achievement of disease remission and reduction of corticosteroid dose. RESULTS: The mean age ± standard deviation of patients was 69 ± 8 years. The main clinical features at TCZ onset were polymyalgia rheumatica (n = 16), asthenia (n = 7), headache (n =5), constitutional symptoms (n = 4), jaw claudication (n = 2), and visual loss (n = 2). Besides corticosteroids and before TCZ onset, 19 of 22 patients had also received several conventional immunosuppressive and/or biologic drugs. Of 22 patients, 19 achieved rapid and maintained clinical improvement following TCZ therapy. Also, after a median follow-up of 9 (interquartile range: 6-19) months, the C-reactive protein level had fallen from 1.9 (1.2-5.4) to 0.2 (0.1-0.9)mg/dL (p < 0.0001) and the erythrocyte sedimentation rate decreased from 44 (20-81) to 12 (2-20)mm/1st hour (p = 0.001). The median dose of prednisone was also tapered from 18.75 (10-45) to 5 (2.5-10)mg/day (p < 0.0001). However, TCZ had to be discontinued in 3 patients due to severe neutropenia, recurrent pneumonia, and cytomegalovirus infection. Moreover, 1 patient died after the second infusion of TCZ due to a stroke in the setting of an infectious endocarditis. CONCLUSION: TCZ therapy leads to rapid and maintained improvement in patients with refractory GCA and/or with unacceptable side effects related to corticosteroids. However, the risk of infection should be kept in mind when using this drug in patients with GCA.
OBJECTIVE: To assess the efficacy of tocilizumab (TCZ) in giant cell arteritis (GCA) patients with refractory disease and/or with unacceptable side effects due to corticosteroids. METHODS: A retrospective multicenter open-label study on 22 GCA patients treated with TCZ at standard dose of 8mg/kg/month. The main outcomes were achievement of disease remission and reduction of corticosteroid dose. RESULTS: The mean age ± standard deviation of patients was 69 ± 8 years. The main clinical features at TCZ onset were polymyalgia rheumatica (n = 16), asthenia (n = 7), headache (n =5), constitutional symptoms (n = 4), jaw claudication (n = 2), and visual loss (n = 2). Besides corticosteroids and before TCZ onset, 19 of 22 patients had also received several conventional immunosuppressive and/or biologic drugs. Of 22 patients, 19 achieved rapid and maintained clinical improvement following TCZ therapy. Also, after a median follow-up of 9 (interquartile range: 6-19) months, the C-reactive protein level had fallen from 1.9 (1.2-5.4) to 0.2 (0.1-0.9)mg/dL (p < 0.0001) and the erythrocyte sedimentation rate decreased from 44 (20-81) to 12 (2-20)mm/1st hour (p = 0.001). The median dose of prednisone was also tapered from 18.75 (10-45) to 5 (2.5-10)mg/day (p < 0.0001). However, TCZ had to be discontinued in 3 patients due to severe neutropenia, recurrent pneumonia, and cytomegalovirus infection. Moreover, 1 patient died after the second infusion of TCZ due to a stroke in the setting of an infectious endocarditis. CONCLUSION:TCZ therapy leads to rapid and maintained improvement in patients with refractory GCA and/or with unacceptable side effects related to corticosteroids. However, the risk of infection should be kept in mind when using this drug in patients with GCA.
Authors: Christian von Kiel; Matthias Dreher; Konstantinos Triantafyllias; Peter Heinz; Andreas Schwarting Journal: Z Rheumatol Date: 2019-09 Impact factor: 1.372
Authors: Judith Land; Wayel H Abdulahad; Jan-Stephan F Sanders; Coen A Stegeman; Peter Heeringa; Abraham Rutgers Journal: Arthritis Res Ther Date: 2016-04-04 Impact factor: 5.156