Jérémy Clément1, Pierre Duffau1, Joel Constans1, Thierry Schaeverbeke1, Jean-Francois Viallard1, Damien Barcat1, Jean-Philippe Vernhes1, Laurent Sailler1, Fabrice Bonnet1. 1. J. Cl é ment, MD, Bordeaux University Hospital, Department of Internal Medicine and Infectious Diseases, Bordeaux; P. Duffau, MD, PhD, Bordeaux University Hospital, Internal Medicine Department, Bordeaux; J. Constans, MD, PhD, Bordeaux University Hospital, Vascular Medicine Department, Saint-Andr Hospital, Bordeaux; T. Schaeverbeke, MD, PhD, Bordeaux University Hospital, Department of Rheumatology, Bordeaux; JF Viallard, MD, PhD, CHU de Bordeaux, Department of Internal Medicine and Infectious Diseases, H ô pital Haut-L é v ê que, Pessac; D. Barcat, MD, CH de Libourne, Department of Internal Medicine, Libourne; JP Vernhes, MD, CH of Libourne, Department of Rheumatology, Libourne; L. Sailler, MD, PhD, Toulouse University Hospital, Department of Internal Medicine, Toulouse; F. Bonnet, MD, PhD, CHU de Bordeaux, Department of Internal Medicine and Infectious Diseases, H ô pital Saint-Andr é, Bordeaux, and Universit é de Bordeaux, INSERM U1219, Bordeaux Population Health Research Center, Bordeaux, France. The authors declare no conflicts of interest. Address correspondence to Dr. F. Bonnet, Service de M é decine Interne and Infectious Diseases, H ô pital Saint-Andr é, CHU de Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux, France. Email: fabrice.bonnet@chu-bordeaux.fr. Accepted for publication January 26, 2021. break /> The authors declare no conflicts of interest. Address correspondence to Dr. F. Bonnet, Department of Internal Medicine and Infectious Diseases, H ô pital Saint-Andr é, CHU de Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux, France. Email: fabrice.bonnet@chu-bordeaux.fr. Accepted for publication January 26, 2021. break /> The authors declare no conflicts of interest. Address correspondence to Dr. F. Bonnet, Department of Internal Medicine and Infectious Diseases, H ô pital Saint-Andr é, CHU de Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux, France. Email: fabrice.bonnet@chu-bordeaux.fr. Accepted for publication January 26, 2021.
Abstract
OBJECTIVE: Tocilizumab (TCZ), an interleukin 6 (IL-6) receptor antagonist, is approved for giant cell arteritis (GCA) as a cortisone-sparing strategy and in refractory patients. This study assessed the real-world efficacy, safety, and long-term outcomes of patients with GCA treated with TCZ. METHODS: We conducted a multicenter retrospective observational study at 3 French centers. All patients aged ≥ 50 years who met the American College of Rheumatology (ACR) criteria, and had received at least 1 dose of TCZ were included. Relapse was defined by therapeutic escalation, such as increased doses of corticosteroids (CS), resumption of CS after weaning, or introduction or intensification of adjuvant therapy. RESULTS: Between 2013 and 2019, 43 patients were included. Patients were followed up for a median 511 days between GCA diagnosis and inclusion, with 34/43 (79%) patients experiencing relapses. At inclusion, median age was 77 years, and median dose of CS was 15 mg/day. After inclusion, the mean cumulative dose of CS was 2.1 g/year vs 9.4 g/year before inclusion (P < 2 × 10-7), with 12/43 (28%) patients experiencing relapses on TCZ. Among 29 patients undergoing TCZ discontinuation, 18 (62%) experienced relapses. Factors associated with relapse after inclusion were introduction of TCZ > 6 months after diagnosis (P = 0.005), absence of ischemic signs at diagnosis (P = 0.006), relapse rate > 0.8/year (P = 0.03), and absence of CS tapering ≤ 5 mg/day (P = 0.03) before inclusion. Serious adverse events occurred in 18/43 patients (42%), including 4 deaths. CONCLUSION: Our results confirm the effectiveness of TCZ for CS sparing, but after discontinuation of treatment, TCZ allows for a prolonged remission in < 50% of patients. Attention must be paid to the tolerance of this long-term treatment in this elderly, heavily treated refractory population.
OBJECTIVE:Tocilizumab (TCZ), an interleukin 6 (IL-6) receptor antagonist, is approved for giant cell arteritis (GCA) as a cortisone-sparing strategy and in refractory patients. This study assessed the real-world efficacy, safety, and long-term outcomes of patients with GCA treated with TCZ. METHODS: We conducted a multicenter retrospective observational study at 3 French centers. All patients aged ≥ 50 years who met the American College of Rheumatology (ACR) criteria, and had received at least 1 dose of TCZ were included. Relapse was defined by therapeutic escalation, such as increased doses of corticosteroids (CS), resumption of CS after weaning, or introduction or intensification of adjuvant therapy. RESULTS: Between 2013 and 2019, 43 patients were included. Patients were followed up for a median 511 days between GCA diagnosis and inclusion, with 34/43 (79%) patients experiencing relapses. At inclusion, median age was 77 years, and median dose of CS was 15 mg/day. After inclusion, the mean cumulative dose of CS was 2.1 g/year vs 9.4 g/year before inclusion (P < 2 × 10-7), with 12/43 (28%) patients experiencing relapses on TCZ. Among 29 patients undergoing TCZ discontinuation, 18 (62%) experienced relapses. Factors associated with relapse after inclusion were introduction of TCZ > 6 months after diagnosis (P = 0.005), absence of ischemic signs at diagnosis (P = 0.006), relapse rate > 0.8/year (P = 0.03), and absence of CS tapering ≤ 5 mg/day (P = 0.03) before inclusion. Serious adverse events occurred in 18/43 patients (42%), including 4 deaths. CONCLUSION: Our results confirm the effectiveness of TCZ for CS sparing, but after discontinuation of treatment, TCZ allows for a prolonged remission in < 50% of patients. Attention must be paid to the tolerance of this long-term treatment in this elderly, heavily treated refractory population.
Authors: Thomas Daikeler; Peter M Villiger; Christophe Schmitt; Laura Brockwell; Mylène Giraudon; Mauro Zucchetto; Lisa Christ; Bettina Bannert Journal: Arthritis Res Ther Date: 2022-06-04 Impact factor: 5.606
Authors: Dan Pugh; Maira Karabayas; Neil Basu; Maria C Cid; Ruchika Goel; Carl S Goodyear; Peter C Grayson; Stephen P McAdoo; Justin C Mason; Catherine Owen; Cornelia M Weyand; Taryn Youngstein; Neeraj Dhaun Journal: Nat Rev Dis Primers Date: 2022-01-06 Impact factor: 65.038
Authors: Owen Cronin; Hannah Preston; Heba Fahmy; Barbara Kuske; Malinder Singh; Naomi Scott; Sean Kerrigan; Lucy Moran; John Harvie; Helen Harris; Barbara Hauser; Neil D McKay Journal: Rheumatol Adv Pract Date: 2022-03-09