ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1878

Tocilizumab in Caucasian Patients with Takayasu Arteritis: Multicenter Study of 54 Patients

Diana Prieto-Peña1, Pilar Bernabeu2, Paloma Vela3, Javier Narvaez4, Jesús Carlos Fernández-López5, Mercedes Freire6, Beatriz González-Alvarez7, Roser Solans-Laqué8, José Luis Callejas9, Norberto Ortego10, Carlos Fernández-Díaz11, Esteban Rubio Romero12, Salvador Garcia-Morillo13, Mauricio Minguez14, Cristina Carballido14, Eugenio De Miguel15, Sheila Melchor16, Eva Salgado17, Beatriz Bravo18, Susana Romero-Yuste19, Juan Salvatierra20, Cristina Hidalgo21, Sara Manrique Arija22, Carlos Romero Gomez23, Patricia Moya24, Noelia Álvarez-Rivas25, Javier Mendizábal-Mateos26, Francisco Ortiz-Sanjuán27, Ivan Perez De Pedro28, Jose L Alonso-Valdivielso29, Laura Perez-Sanchez30, Rosa Roldan31, Nagore Fernandez-Llanio32, Ricardo Gómez de la Torre33, Silvia Suarez33, Mara Jess Montesa Cabrera34, MONICA DELGADO SANCHEZ35, Javier Loricera1, Belén Atienza-Mateo36, Miguel Ángel gonzalez-Gay37 and Ricardo Blanco38, 1Hospital Universitario Marqués de Valdecilla, santander, Spain, 2Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain, 3Hospital General Universitario de Alicante, Alicante, Spain, 4Division of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain, 5Hospital Universitario Juan Canalejo, A Coruña, Spain, 6Rheumatology Service. CHU Coruña, La Coruña, Spain, 7H. NªSª de la Candelaria, Tenerife, Spain, 8Hospital Vall d'Hebron, Barcelona, Spain, 9Hospital San Cecilio, Granada, Spain, 10Medicine Department, Universidad de Granada, Granada, Spain, 11Hospital Universitario Reina Sofía, Murcia, Spain, 12HOSPITAL UNIVERSITARIO VIRGEN DEL ROCIO, Seville, Spain, 13H Virgen del Rocio, Sevilla, Spain, 14H. San Juan, Alicante, Spain, 15Hospital Universitario La Paz, Madrid, Spain, 16H. 12 de Octubre, Madrid, Spain, 17Complejo Hospitalario Universitario de Ourense, Ourense, Spain, 18Hospital Universitario Virgen de las Nieves, Granada, Spain, 19Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain, 20H San Juan, Alicante, Spain, 21Hospital Universitario Salamanca, Salamanca, Spain, 22Hospital Regional de Málaga, Málaga. Spain., Malaga, Spain, 23H. Regional de Malaga, Malaga, Spain, 24Hospital Sant Pau, Barcelona, Spain, 25Hospital San Agustín, Aviles, Spain, 26H. Navarra, Navarra, Spain, 27H. La Fe, Valencia, Spain, 28H. Carlos Haya, Malaga, Spain, 29H. Burgos, Burgos, Spain, 30IMIBIC/Reina Sofia Hospital/University of Córdoba, Córdoba, Spain, 31H. Reina Sofia, Cordoba, Spain, 32H. Arnau de Vilanova, Valencia, Spain, 33H. Asturias, Oviedo, Spain, 34Hospital Universitario Nuestra Seora de la Candelaria, Santa Cruz de Tenerife, Spain, 35H NªSª Candelaria, Tenerife, Spain, 36Group "Research in genetic epidemiology and atherosclerosis of systemic diseases and in bone metabolic diseases of the locomotor system", IDIVAL; and Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain, 37Research group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla; School of Medicine, Universidad de Cantabria, Santander, Spain. Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, 38Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain

Meeting: ACR Convergence 2021

Keywords: , ,

Session Information

Date: Tuesday, November 9, 2021

Title: Vasculitis – Non-ANCA-Associated & Related Disorders Poster II (1862–1888)

Session Type: Poster Session D

Session Time: 8:30AM-10:30AM

Background/Purpose: Tocilizumab (TCZ) has shown to be effective for large vessel vasculitis including Takayasu arteritis (TAK) (1-3). Most evidence in TAK comes from Asian patients. However, white patients seem to have different clinical and prognostic features.

Our aims were to: a) assess the efficacy and safety of TCZ in white patients with refractory TAK, b) determine if clinical improvement correlates with imaging outcomes, c) compare TCZ in monotherapy (TCZMONO) vs combined with conventional immunosuppressive drugs (TCZCOMBO).

Methods: Multicenter study of white patients with refractory TAK who received TCZ.Outcomes variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZMONO and TCZCOMBO was performed.

Results: 54 patients (46 women/8 men; median age 42.0 [32.5-50.5] years). TCZ was started after 12.0 [3.0-31.5] months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%) and 27/36 (75%) at 1, 3, 6 and 12 months, respectively. Prednisone dose was reduced from 30.0 [12.5-50.0] to 5.0 [0.0-5.6] mg/day at 12 months (Table). 10 (26.3%) of the 38 patients in whom an imaging follow-up test was performed showed no radiographic improvement after a median of 9.0 [6.0-14.0] months. 4 of them were in clinical remission.23 (42.6%) patients were on TCZMONO and 31 (57.4%) on TCZCOMBO: MTX (n=28), cyclosporine A (n=2), azathioprine (n=1). Patients on TCZCOMBO were younger (38.0 [27.0-46.0] vs 45 [38.0-57.0] years; p= 0.048), with a trend to longer TAK duration (21.0 [6.0-38.0] vs 6.0 [1.0-23.0] months; p= 0.08) and higher C-reactive protein (2.4 [0.7-5.6] vs 1.3 [0.3-3.3] mg/dL; p=0.16). Despite these differences, similar outcomes were observed in both groups (log rank p=0.862) (Figure). Relevant adverse events were reported in 6 (11.1%) patients, but only 3 developed severe events that required TCZ withdrawal.

Conclusion: TCZ is effective and safe in white patients with refractory TAK. A discordance between clinical and imaging activity assessment may exist.

References:

  1. Prieto Peña D et al. Evidence for uncoupling of clinical and 18-FDG activity of PET/CT scan improvement in tocilizumab-treated patients with large-vessel giant cell arteritis. Clin Exp Rheumatol 2020 Nov 27. PMID: 33253103.
  2. Loricera J, et al. Tocilizumab in patients with Takayasu arteritis: a retrospective study and literature review. Clin Exp Rheumatol 2016; 34:S44-53. PMID: 27050507.
  3. Calderón-Goercke M, et al. Tocilizumab in Giant Cell Arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum 2019; 49:126-35. https://doi.org/10.1016/j.semarthrit.2019.01.003.

TABLE

FIGURE

Disclosures: D. Prieto-Peña, None; P. Bernabeu, None; P. Vela, None; J. Narvaez, None; J. Fernández-López, None; M. Freire, None; B. González-Alvarez, None; R. Solans-Laqué, None; J. Callejas, None; N. Ortego, None; C. Fernández-Díaz, Brystol Myers Squibb, 6; E. Rubio Romero, None; S. Garcia-Morillo, None; M. Minguez, None; C. Carballido, None; E. De Miguel, Roche, 6, 12, Paid instructor, Abbvie, 2, 5, 6, Novartis, 2, 5, 6, 12, Paid instructor, Pfizer, 2, 5, 6, MSD, 6, BMS, 6, UCB, 6, Grunental, 6, Janssen, 6, 12, Paid instructor, Sanofi, 6, Galapagos, 2; S. Melchor, None; E. Salgado, None; B. Bravo, None; S. Romero-Yuste, Abbvie, 2, 6, MSD, 5, Pfizer, 5, Novartis, 5, Biogen, 2, 6, Amgen, 6, Grünenthal, 6, Kern Pharma, 6, Lilly, 2, 6, Roche, 6, Sandoz, 6, Sanofi, 6, UCB, 6, Janssen, 2, 6, Fresenius Kabi, 2, Gebro, 2, BMS, 2, 5, Galapagos, 2; J. Salvatierra, None; C. Hidalgo, None; S. Manrique Arija, None; C. Romero Gomez, None; P. Moya, None; N. Álvarez-Rivas, None; J. Mendizábal-Mateos, None; F. Ortiz-Sanjuán, None; I. Perez De Pedro, None; J. Alonso-Valdivielso, None; L. Perez-Sanchez, None; R. Roldan, None; N. Fernandez-Llanio, None; R. Gómez de la Torre, None; S. Suarez, None; M. Montesa Cabrera, None; M. DELGADO SANCHEZ, None; J. Loricera, None; B. Atienza-Mateo, None; M. gonzalez-Gay, None; R. Blanco, Brystol Myers Squibb, 6.

To cite this abstract in AMA style:

Prieto-Peña D, Bernabeu P, Vela P, Narvaez J, Fernández-López J, Freire M, González-Alvarez B, Solans-Laqué R, Callejas J, Ortego N, Fernández-Díaz C, Rubio Romero E, Garcia-Morillo S, Minguez M, Carballido C, De Miguel E, Melchor S, Salgado E, Bravo B, Romero-Yuste S, Salvatierra J, Hidalgo C, Manrique Arija S, Romero Gomez C, Moya P, Álvarez-Rivas N, Mendizábal-Mateos J, Ortiz-Sanjuán F, Perez De Pedro I, Alonso-Valdivielso J, Perez-Sanchez L, Roldan R, Fernandez-Llanio N, Gómez de la Torre R, Suarez S, Montesa Cabrera M, DELGADO SANCHEZ M, Loricera J, Atienza-Mateo B, gonzalez-Gay M, Blanco R. Tocilizumab in Caucasian Patients with Takayasu Arteritis: Multicenter Study of 54 Patients [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/tocilizumab-in-caucasian-patients-with-takayasu-arteritis-multicenter-study-of-54-patients/. Accessed .

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