Tocilizumab in Giant Cell Arteritis: The Safest and Most Effective Initial Dose of Prednisone

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, Elena Aurrecoechea ⁶, Norberto Ortego ⁴⁴, Francisco Ortiz-Sanjuán ³¹, Montserrat Corteguera ³⁶, Jose Luis Hernández ¹, Miguel Angel González-Gay ⁴⁵ and Ricardo Blanco ⁴⁶, 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, ⁴⁴Systemic Autoimmune Diseases Unit, Hospital Clínico San Cecilio, Granada, Spain, Granada, Spain, ⁴⁵Universidad de Cantabria and IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain, ⁴⁶Rheumatology, Hospital Universitario Marques de Valdecilla, Santander, Spain

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: giant cell arteritis, prednisone, tocilizumab and prednisolone

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: Tocilizumab (TCZ) has been approved for the treatment of Giant Cell Arteritis (GCA). It showed to be effective to induce remission, prevent relapses and decrease the cumulative prednisone dose. However, the glucocorticoids are the mainstay in the acute treatment of GCA.
Our aim was to compare the efficacy and safety of the initial dose of prednisone at the onset of TCZ treatment.

Methods: Retrospective, multicenter study on 134 patients with GCA in treatment with TCZ. We compared two subgroups of patients according to the initial dose of prednisone at TCZ onset. Clinical efficacy, analytical improvement and safety was studied.

Results: We studied 134 patients (101 w/33 m) and made a comparative study between 2 groups: a) TCZ and ≤ 15 mg of prednisone; 68 (50.7%) cases, and b) TCZ and > 15 mg of prednisone, 66 (49,3%) patients. It is summarized in TABLE 1. It was no statistical significance according to age, sex and evolution time of disease. In the group receiving > 15 mg of prednisone, the patients presented more visual involvement (p< 0.001) at TCZ onset. In terms of prolonged remission and relapses no significant difference was seen between both groups. The risk of presenting adverse effects (11.8% vs 36.4%) and severe infections (4.4% vs 19.7%) was related with the prednisone dose, being more frequent in the group with > 15 mg of prednisone (p=0.001 and p=0.006, respectively). In TABLE 2 summarizes the infections of our patients.

Conclusion: According with our results, we can conclude that TCZ is equally effective; in terms of prolonged remission and relapses, with doses ≤ 15 mg of prednisone at treatment onset. Being the most important data, the higher risk to develop adverse effects, as well as infections with higher doses of prednisone.

TABLE 1 Prednisone Dose

TABLE 2 Prednisone Dose

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; E. Aurrecoechea, None; N. Ortego, None; F. Ortiz-Sanjuán, None; M. Corteguera, 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, Aurrecoechea E, Ortego N, Ortiz-Sanjuán F, Corteguera M, Hernández J, González-Gay M, Blanco R. Tocilizumab in Giant Cell Arteritis: The Safest and Most Effective Initial Dose of Prednisone [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/tocilizumab-in-giant-cell-arteritis-the-safest-and-most-effective-initial-dose-of-prednisone/. Accessed .

« Back to 2019 ACR/ARP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/tocilizumab-in-giant-cell-arteritis-the-safest-and-most-effective-initial-dose-of-prednisone/