Response to Tocilizumab in Patients with Giant Cell Arteritis, According to Ischemic vs Systemic Symptoms

Mónica Calderón-Goercke¹, Javier Loricera ², DIANA PRIETO- PENA ³, Santos Castañeda ⁴, Vicente Aldasoro Caceres ⁵, Ignacio Villa ⁶, Alicia Humbría ⁷, Clara Moriano ⁸, Susana Romero-Yuste ⁹, Javier Narváez ¹⁰, Catalina Gómez-Arango ¹¹, Eva Perez Pampín ¹², Rafael Melero ¹³, Elena Becerra-Fernández ¹⁴, Marcelino Revenga ¹⁵, Noelia Álvarez-Rivas ¹⁶, Carles Galisteo ¹⁷, Francisca Sivera ¹⁸, Alejandro Olivé-Marqués ¹⁹, María Álvarez del buergo ²⁰, Luisa Marena-Rojas ²¹, Carlos Fernández-López ²², Francisco Navarro ²³, E. Raya ²⁴, Eva Galindez-Agirregoikoa ²⁵, Beatriz Arca ²⁶, Roser Solans-Laqué ²⁷, Arantxa Conesa ²⁸, Cristina Hidalgo ²⁹, Carlos Vazquez ³⁰, Jose Andrés Román-Ivorra ³¹, Pau Lluch ³², Sara Manrique ³³, P. Vela ³⁴, Eugenio de Miguel ³⁵, Carmen Torres-Martín ³⁶, Juan Carlos Nieto ³⁷, Carmen Ordas-Calvo ³⁸, Eva salgado-Pérez ³⁹, Cristina Luna-Gómez ⁴⁰, F. Javier Toyos-Sáenz De Miera ⁴¹, Nagore Fernández-Llanio ⁴², Antonio García ⁴³, Carmen Larena ⁴⁴, María Varela-García ⁵, Raquel Dos Santos ⁴⁵, Norberto Ortego ⁴⁶, Jose Luis Hernández ¹, Miguel Angel González-Gay ⁴⁷ and Ricardo Blanco ⁴⁸, ¹Hospital Marqués de Valdecilla, Santander, Cantabria, Spain, ²Rheumatology Department. Hospital Marqués de Valdecilla, Santander, Cantabria, Spain, ³Rheumatology, Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain, ⁴Rheumatology Department, Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain, Madrid, Spain, ⁵Complejo Hospitalario de Navarra, Navarra, Navarra, Spain, ⁶Hospital de Sierrallana, Torrelavega, Cantabria, Spain, ⁷Hospital de La Princesa, Madrid, Madrid, Spain, ⁸Complejo Asistencial Universitario de León, León, Castilla y Leon, Spain, ⁹Complejo Hospitalario Universitario Pontevedra, Pontevedra, Galicia, Spain, ¹⁰Rheumatology Department, Hospital Universitario de Bellvitge, Barcelona, Spain, Barcelona, Catalonia, Spain, ¹¹Hospital Alto Deba, Mondragon, Pais Vasco, Spain, ¹²Division of Rheumatology, Instituto de Investigación Sanitaria-Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain, Santiago de Compostela, Spain, ¹³Complexo Hospitalario Universitario de Vigo, Vigo, Galicia, Spain, ¹⁴Hospital de Torrevieja, Alicante, Comunidad Valenciana, Spain, ¹⁵Hospital Ramón y Cajal, Madrid, Madrid, Spain, ¹⁶Hospital Universitario Lucus Augusti, Lugo, Galicia, Spain, ¹⁷Hospital Parc Taulí, Barcelona, Catalonia, Spain, ¹⁸Hospital General Universitario de Elda, Elda, Spain, ¹⁹Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain, ²⁰Hospital Río Carrión, Palencia, Castilla y Leon, Spain, ²¹Hospital La Mancha Centro, Alcázar de San Juan, Castilla-La Mancha, Spain, ²²Servicio de Reumatología. Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC). As Xubias, 15006. A Coruña, España, A Coruña, Spain, ²³Hospital General Universitario de Elche, Alicante, Comunidad Valenciana, Spain, ²⁴Hospital San Cecilio, Granada, Andalucia, Spain, ²⁵Hospital de Basurto, Bilbao, Pais Vasco, Spain, ²⁶Hospital Universitario San Agustín, Avilés, Asturias, Spain, ²⁷Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain., Barcelona, Catalonia, Spain, ²⁸Hospital General Universitario de Castellón, Castellón, Comunidad Valenciana, Spain, ²⁹Hospital Clínico Universitario de Salamanca, Salamanca, Castilla y Leon, Spain, ³⁰Hospital Miguel Servet, Zaragoza, Aragon, Spain, ³¹Hospital Universitario y Politécnico La Fe, Valencia, Comunidad Valenciana, Spain, ³²Hospital Mateu Orfila, Menorca, Islas Baleares, Spain, ³³Hospital Regional de Málaga, Málaga, Andalucia, Spain, ³⁴Hospital General Universitario de Alicante, Alicante, Comunidad Valenciana, Spain, ³⁵Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain, ³⁶Complejo Asistencial de Ávila, Ávila, Castilla y Leon, Spain, ³⁷Rheumatology Department. Hospital Gregorio Marañón, Madrid, Madrid, Spain, ³⁸Hospital Cabueñes, Gijón, Asturias, Spain, ³⁹Complejo Hospitalario Universitario de Ourense, Ourense, Galicia, Spain, ⁴⁰Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Canarias, Spain, ⁴¹Hospital Universitario Virgen Macarena, Sevilla, Andalucia, Spain, ⁴²Hospital Arnau de Vilanova, Lérida, Catalonia, Spain, ⁴³Hospital Virgen de las Nieves, Granada, Andalucia, Spain, ⁴⁴Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain, ⁴⁵Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Galicia, Spain, ⁴⁶Systemic Autoimmune Diseases Unit, Hospital Clínico San Cecilio, Granada, Spain, Granada, Spain, ⁴⁷Universidad de Cantabria and IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain, ⁴⁸Rheumatology, Hospital Universitario Marques de Valdecilla, Santander, Spain

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: giant cell arteritis, tocilizumab and CLINICAL MANIFESTATIONS

Session Information

Date: Tuesday, November 12, 2019

Title: Vasculitis – Non-ANCA-Associated & Related Disorders Poster III: Giant Cell Arteritis

Session Type: Poster Session (Tuesday)

Session Time: 9:00AM-11:00AM

Background/Purpose: In Giant Cell Arteritis (GCA) two dominant cytokine clusters have been linked to disease activity, IL-6 – IL-17 axis (Th17) and IL-12 – IFN γ axis (Th1). The first one related to systemic symptoms and the second route responsible for ischemic symptoms. Tocilizumab (TCZ) performs its effect mainly by inhibiting Th17 axis and terminally Th1 route.
Our aim was to evaluate the effect of TCZ on ischemic and systemic symptoms throughout the follow-up.

Methods: Retrospective, multicenter study of 134 patients diagnosed of GCA on treatment with TCZ. We evaluate the efficacy of TCZ by improving ischemic (visual involvement, headache, jaw claudication) and systemic symptoms (fever, constitutional syndrome, polymyalgia rheumatica (PMR)).

Results: We evaluated 134 patients (101 w/33 m) and its main symptoms at TCZ onset, TABLE. 73 (54.5%) patients presented PMR followed by headache in 70 (52.2%) cases, constitutional syndrome in 31 (23.1%) and visual involvement in 28 (20.9%) patients. After one month of treatment there was an important clinical improvement, persisting in 13,6% of patients PMR, 10.6% headache and 10.6% visual involvement. Throughout the follow-up, the improvement of ischemic symptoms was slower. At month 12, in 5.6% (4) of patients persisted with visual impairment, and 2.8% (2) patients presented headache and constitutional syndrome. However, the analytical improvement was statistically significant from the first month and sustained during follow-up.

Conclusion: According to the results of our study, we can conclude that in clinical practice, ischemic symptoms take longer to improve than systemic symptoms; being visual affectation the most frequent symptom after 12 months of follow-up.

TABLE 1 Manifestation

Disclosure: M. Calderón-Goercke, None; J. Loricera, None; D. PRIETO- PENA, None; S. Castañeda, None; V. Aldasoro Caceres, None; I. Villa, None; A. Humbría, None; C. Moriano, None; S. Romero-Yuste, None; J. Narváez, None; C. Gómez-Arango, None; E. Perez Pampín, None; R. Melero, None; E. Becerra-Fernández, None; M. Revenga, None; N. Álvarez-Rivas, None; C. Galisteo, None; F. Sivera, None; A. Olivé-Marqués, None; M. Álvarez del buergo, None; L. Marena-Rojas, None; C. Fernández-López, None; F. Navarro, None; E. Raya, None; E. Galindez-Agirregoikoa, None; B. Arca, None; R. Solans-Laqué, None; A. Conesa, None; C. Hidalgo, None; C. Vazquez, None; J. Román-Ivorra, None; P. Lluch, None; S. Manrique, None; P. Vela, None; E. de Miguel, AbbVie, 2, 5, 8, BMS, 8, BMS, MSD, UCB, Roche, 8, MSD, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Roche, 8, UCB, 8; C. Torres-Martín, None; J. Nieto, None; C. Ordas-Calvo, None; E. salgado-Pérez, None; C. Luna-Gómez, None; F. Toyos-Sáenz De Miera, None; N. Fernández-Llanio, None; A. García, None; C. Larena, None; M. Varela-García, None; R. Dos Santos, None; N. Ortego, None; J. Hernández, None; M. González-Gay, AbbVie, 2, 5, 8, Abbvie, 2, 5, 8, Celgene, 5, 8, Eli Lilly, 2, 5, EliLilly, 2, 5, Jansen, 2, Janssen, 2, MSD, 2, 5, 8, Novartis, 2, 5, Pfizer, 5, 8, Roche, 2, 5, 8, Sanofi, 2, 5, 8, Sobi, 5, 8; R. Blanco, None.

To cite this abstract in AMA style:

Calderón-Goercke M, Loricera J, PRIETO- PENA D, Castañeda S, Aldasoro Caceres V, Villa I, Humbría A, Moriano C, Romero-Yuste S, Narváez J, Gómez-Arango C, Perez Pampín E, Melero R, Becerra-Fernández E, Revenga M, Álvarez-Rivas N, Galisteo C, Sivera F, Olivé-Marqués A, Álvarez del buergo M, Marena-Rojas L, Fernández-López C, Navarro F, Raya E, Galindez-Agirregoikoa E, Arca B, Solans-Laqué R, Conesa A, Hidalgo C, Vazquez C, Román-Ivorra J, Lluch P, Manrique S, Vela P, de Miguel E, Torres-Martín C, Nieto J, Ordas-Calvo C, salgado-Pérez E, Luna-Gómez C, Toyos-Sáenz De Miera F, Fernández-Llanio N, García A, Larena C, Varela-García M, Dos Santos R, Ortego N, Hernández J, González-Gay M, Blanco R. Response to Tocilizumab in Patients with Giant Cell Arteritis, According to Ischemic vs Systemic Symptoms [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/response-to-tocilizumab-in-patients-with-giant-cell-arteritis-according-to-ischemic-vs-systemic-symptoms/. Accessed .

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