Tocilizumab in Monotherapy vs. Combined in Aortitis Associated with Giant Cell Arteritis. Multicenter Open-label Study of 196 Patients

Adrián Martín-Gutiérrez¹, Javier Loricera², Carmen Secada Gómez³, Javier Narvaez-García⁴, Olga Maíz Alonso⁵, Iñigo Hernández-Rodríguez⁶, Susana Romero Yuste⁷, Eugenio De Miguel⁸, Eva Galindez-Agirregoikoa⁹, ivan Ferraz-Amaro¹⁰, Julio Sánchez-Martín¹¹, Patricia Moya Albarado¹², Cristina Campos Fernández¹³, Fernando Lopez-Gutierrez¹⁴, Santos Castañeda¹⁵ and Ricardo Blanco-Alonso¹⁶, 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 Universitario de Bellvitge, Barcelona, Spain, ⁵3Hospital Universitario de Donosti, San Sebastian, Spain, San Sebastian, Pais Vasco, Spain, ⁶Complejo Hospitalario Universitario de Vigo, Vigo, Spain, ⁷Department of Rheumatology, University Hospital Complex of Pontevedra, Pontevedra, Spain, ⁸Hospital Universitario La Paz, Madrid, Spain, ⁹BASURTO UNIVERSITY HOSPITAL, BILBAO, Spain, ¹⁰Rheumatology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canarias, Spain, ¹¹Hospital Universitario 12 de Octubre, Madrid, Spain, ¹²Hospital de San Pau, Barcelona, Spain, ¹³Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain, ¹⁴Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain, ¹⁵Hospital Universitario de la Princesa, Madrid, Spain, ¹⁶Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Immunopathology group, Santander, Spain

Meeting: ACR Convergence 2024

Keywords: Biologicals, giant cell arteritis, Imaging, Nuclear Medicine, Vasculitis

Session Information

Date: Saturday, November 16, 2024

Title: Vasculitis – Non-ANCA-Associated & Related Disorders Poster I

Session Type: Poster Session A

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

Background/Purpose: Aortitis related to Giant Cell Arteritis (GCA-aortitis) is a frequent and potential severe complication. Tocilizumab (TCZ) was approved in GCA, but the efficacy in GCA- aortitis has not been specifically studied in randomized clinical trials.
Our aim is to assess the effectiveness and safety of TCZ in monotheraphy compared with combined in a wide series of GCA-aortitis.

Methods: Multicentre observational study with GCA-aortitis treated with TCZ. GCA was diagnosed by: a) ACR criteria, b) temporal artery biopsy, and/or c) imaging techniques. Aortitis was diagnosed mainly by PET/CT. Main outcomes were EULAR and imaging remission (considered when vascular FDG uptake was less than liver uptake in 18 F-FDG PET/CT). Others were clinical remission, corticosteroid-sparing effect, TCZ optimization and adverse effects.

Results: We studied 196 patients with GCA-aortitis treated with TCZ (136 in monotherapy/60 combined with others DMARDs). Figure 1. After 24 months, there were statistical differences in imaging and complete remission (17.2% vs 42.1%) Figure 2. Nevertheless, there were no differences in clinical and EULAR remission.

Conclusion: In GCA-aortitis, TCZ therapy combined with DMARDs could be more effective than in monotherapy in imaging and complete remission.

Abbreviations: ACR: American College of Rheumatology (36,37); ACR/LVV: Large vessel vasculitis: criteria of GCA ACR with a positive image suggestive for aortitis; AZA: azathioprine; CQ: cloroquine; CRP: C-reactive protein ; DMARDs : disease-modifying antirheumatic drugs; ESR: erythrocyte sedimentation rate ; GiACTA: (38) Hb: hemoglobine; HCQ: hydroxychloroquine; IFX: infliximab; IQR: interquartile range; LFN: leflunomide ; MMF: mycophenolate mofetil; n : number; PET/CT: positron emission tomography scan; PMR: polymyalgia rheumatica; RTX: rituximab; SD: standard deviation; SSZ: sulfasalazine; TCZ: tocilizumab.
The significance of the imaging tests was calculated according to the number of tests performed.
Statistical significance is expressed as bold characters.

(A) Serum C-reactive protein (CRP), B) Prednisone dose (mg/day) (C), (D) Clinical, EULAR, imaging and complete remission at 12 and 24 month.

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; J. Narvaez-García: None; O. Maíz Alonso: None; I. Hernández-Rodríguez: 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; 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; 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, Narvaez-García J, Maíz Alonso O, Hernández-Rodríguez I, Romero Yuste S, De Miguel E, Galindez-Agirregoikoa E, Ferraz-Amaro i, Sánchez-Martín J, Moya Albarado P, Campos Fernández C, Lopez-Gutierrez F, Castañeda S, Blanco-Alonso R. Tocilizumab in Monotherapy vs. Combined in Aortitis Associated with Giant Cell Arteritis. Multicenter Open-label Study of 196 Patients [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/tocilizumab-in-monotherapy-vs-combined-in-aortitis-associated-with-giant-cell-arteritis-multicenter-open-label-study-of-196-patients/. Accessed .

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