Date: Monday, November 9, 2020
Session Type: Poster Session D
Session Time: 9:00AM-11:00AM
Background/Purpose: Tocilizumab (TCZ) represents a potent new therapeutic principle for patients with GCA, however, data on efficacy and safety in patients who present with visual affection is still limited. We sought to study the outcome of patients with GCA and visual affection treated with TCZ.
Methods: This retrospective analysis was performed on all patients with GCA and visual disturbances consecutively recruited between April 2013 and May 2020 who underwent treatment with tocilizumab in addition to corticosteroids.
Results: 19 GCA patients (14 women, 5 male) with a mean age of 73.4 + 10 yrs at GCA diagnosis and 28 affected eyes were treated with tocilizumab in addition to corticosteroids.
4/19 patients presented with visual disturbances on oral prednisone and 2/19 patients were on csDMARDs (leflunomide, MTX) for polymyalgia. 2 patients experienced unilateral blindness while receiving iv pulse corticosteroids. AAION was diagnosed in 23/28 eyes, PION in 1/28 eyes and occlusion of the central retinal artery in 4/28 eyes. Loss of vision below 0.1 BCVA occurred in 12/28 eyes. Non patients had bilateral blindness at baseline. 5/28 eyes were affected by sectorial anopsia, impaired vision was reported in 11/28 eyes. 17 patients were treated with TCZ iv 8mg/kg every 4 weeks, 2 patients received TCZ sc at 162mg every 2 weeks.
All patients with visual symptoms received intravenous steroid boluses, followed by predni-sone 1mg/kg/day with subsequent tapering.
Mean disease duration before initiation of tocilizumab was 1.8 + 1.7 months. 11/19 patients started with TCZ within 6 weeks after diagnosis of GCA, in 3 patients TCZ was started because of refractory and/or relapsed disease.
Mean duration of TCZ therapy was 18.9 + 11.5 months. 14/19 patients were able to stop steroids (GC) after a mean duration of 16.7 + 14.8 months and have been steroid-free for an average time of 15 + 10.4 months. In addition to cessation of GC, 8 patients have discon-tinued TCZ, 2 patients relapsed after 11 and 14 months. At present, 6 patients remain drug-free for 3 to 28 months (16 + 11 months). None of the 12 eyes with vision < 0.1 BCVA recovered, but no new vision disturbances occurred during TCZ or after cessation of either TCZ or GC.
Two patients died during follow-up for reasons unrelated to GCA or TCZ. Overall tolerability of TCZ was good, complications were predominantly vascular (2 patients with VTE, one NSTEMI, one stroke and the development of an aortic aneurysm).
Conclusion: Inhibition of IL-6 with TCZ represents a valuable treatment option to prevent deterioration of visual complications in GCA patients with initial visual impairment.
To cite this abstract in AMA style:Rubbert Roth A, Tschuppert S, Neumann T, Benecke U, Pirker I, von Kempis J. Efficacy and Safety of Tocilizumab in Patients with Giant Cell Arteritis and Visual Impairment [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/efficacy-and-safety-of-tocilizumab-in-patients-with-giant-cell-arteritis-and-visual-impairment/. Accessed November 26, 2020.
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