Tocilizumab in giant cell arteritis: Multicenter open-label study of 22 patients

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 8 m...

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Published in:Seminars in arthritis and rheumatism 2015-06, Vol.44 (6), p.717-723
Main Authors: Loricera, Javier, Blanco, Ricardo, Hernández, José L, Castañeda, Santos, Mera, Antonio, Pérez-Pampín, Eva, Peiró, Enriqueta, Humbría, Alicia, Calvo-Alén, Jaime, Aurrecoechea, Elena, Narváez, Javier, Sánchez-Andrade, Amalia, Vela, Paloma, Díez, Elvira, Mata, Cristina, Lluch, Pau, Moll, Concepción, Hernández, Íñigo, Calvo-Río, Vanesa, Ortiz-Sanjuán, Francisco, González-Vela, Carmen, Pina, Trinitario, González-Gay, Miguel Á
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Antibodies, Monoclonal, Humanized - therapeutic use
Biological therapy
Blood Sedimentation
C-Reactive Protein - immunology
Female
Giant cell arteritis
Giant Cell Arteritis - complications
Giant Cell Arteritis - drug therapy
Giant Cell Arteritis - immunology
Humans
Large-vessel vasculitis
Male
Middle Aged
Polymyalgia Rheumatica - drug therapy
Polymyalgia Rheumatica - etiology
Polymyalgia Rheumatica - immunology
Retrospective Studies
Rheumatology
Tocilizumab
Treatment Outcome
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Summary: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 8 mg/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.
ISSN:0049-0172
1532-866X
DOI:10.1016/j.semarthrit.2014.12.005