Development and Outcome of Aortic Complications During Tocilizumab (TCZ) Treatment of GCA and Histopathologic Evidence of Residual Inflammation

Andrea Rubbert-Roth¹, Peter Karl Bode ², Thomas Langenegger ³, Claudia Pfofe ⁴, Thomas Neumann ⁵, Olaf Chan-Hi Kim ⁶ and Johannes von Kempis ⁷, ¹Division of Rheumatology, Kantonsspital St. Gallen, St. Gallen, Sankt Gallen, Switzerland, ²Institute of Pathology and Molecular Pathology, University Hospital of Zurich, Zuerich, Switzerland, ³Rheumatology Clinic Zug, Zug, Switzerland, ⁴Pathology Institute Triemli, Zurich, Zuerich, Switzerland, ⁵Division of Rheumatology and Immunolog, Kantonsspital St. Gallen, St. Gallen, Sankt Gallen, Switzerland, ⁶Department of Radiology, Kantonsspital St Gallen, St.Gallen, Switzerland, ⁷Division of Rheumatology, Kantonsspital St Gallen, St.Gallen, Switzerland

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: giant cell arteritis and tocilizumab

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: GCA may affect the aorta and lead to dissections and aortic aneurysms. TCZ treatment may control aortic inflammation as demonstrated by CRP normalization and imaging data. However, limited data is available on the histopathological findings obtained from patients who undergo surgery because of aortic complications during TCZ.

Methods: We performed a retrospective case series of 5 patients with GCA treated with TCZ, who presented in our clinic between 2011 and 2019. Three patients underwent surgery and aortic specimen underwent histopathologic examination

Results: We report on 5 female patients with a mean age of 69 + 18 yrs, diagnosed with GCA involving the aorta. 3 patients presented with aneurysms at the time of diagnosis, 1 patient with aortic aneurysm and another patient with dissection developed these complications during TCZ therapy. An enlargement of pre-existing aneurysms was observed in 2 patients after stopping TCZ (after a time interval of 10 weeks and 4 months, respectively). Both patients were not eligible for surgical intervention and died during F/up. 3 patients (2 with aortic aneurysm, 1 with dissection) underwent surgery after having been on TCZ on 7 weeks, 9 months, and 4 years. Imaging before surgery showed remission on MRI and PET-CT, respectively. At the time of surgery, all 3 patients had a normal CRP. Histopathological evaluation of the aortic wall showed persistent lymphoplasmacellular infiltrates (predominantly CD3⁺CD4⁺ T cells in patient 1) and, in addition, giant cells in pat 2 and 3.

Conclusion: Aortic aneurysms and dissections may occur in patients with aortic involvement during treatment with TCZ, suggesting that regular imaging is necessary in this patient population. Residual inflammation might present an additional risk factor for aortic complications.

Disclosure: A. Rubbert-Roth, None; P. Bode, None; T. Langenegger, None; C. Pfofe, None; T. Neumann, None; O. Kim, None; J. von Kempis, None.

To cite this abstract in AMA style:

Rubbert-Roth A, Bode P, Langenegger T, Pfofe C, Neumann T, Kim O, von Kempis J. Development and Outcome of Aortic Complications During Tocilizumab (TCZ) Treatment of GCA and Histopathologic Evidence of Residual Inflammation [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/development-and-outcome-of-aortic-complications-during-tocilizumab-tcz-treatment-of-gca-and-histopathologic-evidence-of-residual-inflammation/. Accessed .

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