Factors Associated with Relapse in Giant Cell Arteritis Treated with Tocilizumab. Multicenter Open-label Study of 407 Patients

Adrián Martín-Gutiérrez¹, Javier Loricera², Carmen Secada Gómez³, Clara Moriano⁴, Javier Narvaez-García⁵, Vicente Aldasoro⁶, Olga Maíz Alonso⁷, Iñigo Hernández-Rodríguez⁸, Paloma Vela-Casasempere⁹, Susana Romero Yuste¹⁰, Eugenio De Miguel¹¹, Eva Galindez-Agirregoikoa¹², Jesus C. Fernandez-López¹³, ivan Ferraz-Amaro¹⁴, Julio Sánchez-Martín¹⁵, José Luis Callejas¹⁶, Patricia Moya Albarado¹⁷, Cristina Campos Fernández¹⁸, Fernando Lopez-Gutierrez¹⁹, Santos Castañeda²⁰ and Ricardo Blanco-Alonso²¹, and the Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group, ¹Hospital Universitario Marques de Valdecilla, IDIVAL, Renedo de Piélagos, Cantabria, Spain, ²Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ³Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ⁴Hospital León, LEON, Spain, ⁵Hospital Universitario de Bellvitge, Barcelona, Spain, ⁶Hospital Universitario de Navarra, Pamplona, Spain, ⁷3Hospital Universitario de Donosti, San Sebastian, Spain, San Sebastian, Pais Vasco, Spain, ⁸Complejo Hospitalario Universitario de Vigo, Vigo, Spain, ⁹Hospital General Universitario Alicante, Alicante, Spain, ¹⁰Department of Rheumatology, University Hospital Complex of Pontevedra, Pontevedra, Spain, ¹¹Hospital Universitario La Paz, Madrid, Spain, ¹²BASURTO UNIVERSITY HOSPITAL, BILBAO, Spain, ¹³11Rheumatology, Hospital Universitario Juan Canalejo, A Coruña, Spain., A Coruña, Spain, ¹⁴Rheumatology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canarias, Spain, ¹⁵Hospital Universitario 12 de Octubre, Madrid, Spain, ¹⁶Systemic Autoimmune Diseases Unit, Hospital Clinico San Cecilio, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Granada, Spain, ¹⁷Hospital de San Pau, Barcelona, Spain, ¹⁸Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain, ¹⁹Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain, ²⁰Hospital Universitario de la Princesa, Madrid, Spain, ²¹Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Immunopathology group, Santander, Spain

Meeting: ACR Convergence 2024

Keywords: Biologicals, giant cell arteritis, risk factors, Vasculitis

Session Information

Date: Sunday, November 17, 2024

Title: Miscellaneous Rheumatic & Inflammatory Diseases Poster II

Session Type: Poster Session B

Session Time: 10:30AM-12:30PM

Background/Purpose: Tocilizumab (TCZ) is the only biological drug approved for the treatment of giant cell arteritis (GCA). Clinical trials were performed with intravenous (IV) and subcutaneous (SC) TCZ in a phase-2, and phase-3 (GiACTA) studies, respectively. Interestingly, around a quarter of GCA patients have a relapse during TCZ treatment. Our aim was to assess the factors associated with relapses in a wide series of GCA patients in a real-world setting.

Methods: Multicenter observational study of 407 patients with GCA treated with TCZ. The diagnosis of GCA was performed between 2016 and 2021 according to: a) 1990 ACR criteria, b) temporal artery biopsy, and/or c) imaging evaluation techniques. The variables collected at TCZ initiation were demographics, clinical manifestations, laboratory, temporal artery biopsy, imaging findings, prednisone-equivalent dose and previous therapies. Patients with and without relapses were compared in a bivariate analysis. Multivariate logistic regression was performed to determine factors associated with relapse.

Results: After a mean follow-up of 25.3±21.7 months, GCA relapses were observed in 63 of 407 (15.5%) patients. No significant differences were observed between both groups (with/without relapses) in demographic, clinical and laboratory characteristics or in prednisone dose at initiation of TCZ. Interestingly, the set of variables associated with GCA relapses were: use of IV TCZ, combination of TCZ, optimization of TCZ and TCZ initiation ≥6 months after diagnosis. (Figure 1,2)

Conclusion: GCA relapse seems related mainly to TCZ schedule including IV use, combination use of TCZ, as well as, optimization of TCZ and initiation of TCZ after 6 months of diagnosis.

Abbreviations (in alphabetical order): bDMARDs: biological disease-modifying antirheumatic drugs; cGCA: cranial giant cell arteritis (GCA); CRP: C-reactive protein; ecGCA: extracranial; ESR: erythrocyte sedimentation rate; Hb: haemoglobin; IQR: interquartile range; IV: intravenous; n: number; PMR: polymyalgia rheumatica; scIS: synthetic conventional immunosuppressant drugs; SC: subcutaneous; SD: standard deviation; TCZ: tocilizumab. Statistical significance is specified as bold characters.

Abbreviations (in alphabetical order): Hb: hemoglobin; IV: intravenous; SC: subcutaneous; TCZ: tocilizumab.
Results were adjusted by the variables: “age at TCZ initiation”, “fever at TCZ initiation”, “previous/current smoking history at TCZ initiation”, “Hb at TCZ initiation”. Statistical significance is specified as bold characters.

Disclosures: A. Martín-Gutiérrez: None; J. Loricera: AstraZeneca, 2, 6, Celgene, 2, 6, Eli Lilly, 5, Janssen, 5, Merck/MSD, 2, 5, 6, Novartis, 12, Formation/Congress attendance, Pfizer, 5, Roche, 2, 5, 6, UCB, 2, 5, 6; C. Secada Gómez: None; C. Moriano: None; J. Narvaez-García: None; V. Aldasoro: None; O. Maíz Alonso: None; I. Hernández-Rodríguez: None; P. Vela-Casasempere: None; S. Romero Yuste: AstraZeneca, 5; E. De Miguel: AbbVie/Abbott, 5, 6, BMS, 5, 6, Eli Lilly, 5, 6, Grunental, 5, 6, Janssen, 5, 6, Merck/MSD, 5, 6, Novartis, 5, 6, Pfizer, 5, 6, Roche, 5, 6, sanofi, 5, 6, UCB, 5, 6; E. Galindez-Agirregoikoa: AbbVie/Abbott, 6, Amgen, 6, Eli Lilly, 6, Janssen, 6, Novartis, 6, Pfizer, 6, UCB, 6; J. Fernandez-López: None; i. Ferraz-Amaro: AbbVie/Abbott, 5, 6, Celgene, 6, Janssen, 5, Merck/MSD, 5, 6, Pfizer, 6, Roche, 5, 6, sanofi, 6; J. Sánchez-Martín: None; J. Callejas: None; P. Moya Albarado: None; C. Campos Fernández: None; F. Lopez-Gutierrez: AstraZeneca, 12, Formation/Congress attendance, 12, Formation/Congress attendance, Novartis, 12, Formation/congress attendance; S. Castañeda: Bristol-Myers Squibb(BMS), 2, 6, Eli Lilly, 2, 6, Merck/MSD, 2, 5, 6, Pfizer, 5, Roche, 2, 6, UCB, 2, 5; R. Blanco-Alonso: AbbVie, 2, 5, 6, Bristol-Myers Squibb, 2, 6, Galapagos, 6, Janssen, 2, 6, Lilly, 2, 6, MSD, 2, 5, 6, Pfizer, 2, 6, Roche, 2, 5, 6.

To cite this abstract in AMA style:

Martín-Gutiérrez A, Loricera J, Secada Gómez C, Moriano C, Narvaez-García J, Aldasoro V, Maíz Alonso O, Hernández-Rodríguez I, Vela-Casasempere P, Romero Yuste S, De Miguel E, Galindez-Agirregoikoa E, Fernandez-López J, Ferraz-Amaro i, Sánchez-Martín J, Callejas J, Moya Albarado P, Campos Fernández C, Lopez-Gutierrez F, Castañeda S, Blanco-Alonso R. Factors Associated with Relapse in Giant Cell Arteritis Treated with Tocilizumab. Multicenter Open-label Study of 407 Patients [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/factors-associated-with-relapse-in-giant-cell-arteritis-treated-with-tocilizumab-multicenter-open-label-study-of-407-patients/. Accessed .

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