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 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: Javier Loricera, Ricardo Blanco, José L Hernández, Santos Castañeda, Antonio Mera, Eva Pérez-Pampín, Enriqueta Peiró, Alicia Humbría, Jaime Calvo-Alén, Elena Aurrecoechea, Javier Narváez, Amalia Sánchez-Andrade, Paloma Vela, Elvira Díez, Cristina Mata, Pau Lluch, Concepción Moll, Íñigo Hernández, Vanesa Calvo-Río, Francisco Ortiz-Sanjuán, Carmen González-Vela, Trinitario Pina, Miguel Á González-Gay
• Journal: Seminars in arthritis and rheumatism (Semin Arthritis Rheum) Vol. 44 Issue 6 Pg. 717-23 (Jun 2015) ISSN: 1532-866X [Electronic] United States
• PMID: 25697557 (Publication Type: Clinical Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Antibodies, Monoclonal, Humanized
• C-Reactive Protein
• tocilizumab

Topics

• Aged
• Aged, 80 and over
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Blood Sedimentation
• C-Reactive Protein (immunology)
• Female
• Giant Cell Arteritis (complications, drug therapy, immunology)
• Humans
• Male
• Middle Aged
• Polymyalgia Rheumatica (drug therapy, etiology, immunology)
• Retrospective Studies
• Treatment Outcome