Utility of Optimization of Tocilizumab Therapy in Giant Cell Arteritis: A Multicenter Study of 471 Patients

Fabricio Benavides Villanueva¹, Cristina Corrales¹, Javier Loricera², Monica Calderón-Goercke¹, Clara Moriano³, Santos Castañeda⁴, FRANCISCO JAVIER NARVAEZ⁵, Vicente Aldasoro⁶, Olga Maiz⁷, Rafael Melero⁸, Juan Ignacio Villa⁹, Paloma Vela-Casampere¹⁰, Susana Romero Yuste¹¹, José Luis Callejas¹², Eugenio De Miguel¹³, Eva Galíndez-Agirregoikoa¹⁴, Francisca Sivera¹⁵, Jesús Carlos Fernández-López¹⁶, Carles Galisteo¹⁷, Ivan Ferraz Amaro¹⁸, JULIO SANCHEZ MARTIN¹, Lara Sánchez-Bilbao¹, Jose Luis Hernández¹, Miguel Angel Gonzalez Gay¹⁹ and Ricardo Blanco², ¹Hospital Universitario Marqués de Valdecilla, Santander, Spain, ²Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ³Complejo Asistencial Universitario de León, León, Spain, ⁴Division of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain, ⁵Hospital de Bellvitge, Barcelona, Spain, ⁶Hospital Universitario de Navarra, Pamplona, Spain, ⁷Hospital Universitario de Donostia, San Sebastián, Spain, ⁸Complexo Hospitalario Universitario de Vigo, Vigo, Spain, ⁹Hospital Sierrallana, Torrelavega, Spain, ¹⁰Hospital General Universitario Alicante, Alicante, Spain, ¹¹Complexo Hospitalario Universitario, Pontevedra, Spain, ¹²Hospital San Cecilio, Granada, Andalucia, Spain, ¹³Hospital Universitario La Paz, Madrid, Spain, ¹⁴Basurto University Hospital, Bilbao, Spain, ¹⁵Hospital Universitario de Elda, San Vicente del Raspeig, Spain, ¹⁶Complejo H. Universitario de A Coruña, A Coruña, Spain, ¹⁷Hospital Parc Tauli,, Sabadel, Spain, ¹⁸Division of Rheumatology. Hospital Universitario de Canarias. Spain., Santa Cruz de Tenerife, Spain, ¹⁹Hospital Universitario Marques de Valdecilla, Lugo, Spain

Meeting: ACR Convergence 2022

Keywords: Biologicals, giant cell arteritis, Response Criteria, Therapy, alternative

Session Information

Date: Saturday, November 12, 2022

Title: Vasculitis – Non-ANCA-Associated and Related Disorders Poster I: Giant Cell Arteritis

Session Type: Poster Session A

Session Time: 1:00PM-3:00PM

Background/Purpose: Tocilizumab (TCZ) has shown to be useful in the treatment of large-vessel vasculitis, including giant cell arteritis (GCA). There is general agreement on the initial and the standard maintenance dose of TCZ. However, information on duration and optimization of TCZ in GCA is really scarce./

Our aim was to assess the effectiveness and safety of TCZ therapy optimization in an unselected wide series of GCA in real-world clinical practice.

Methods: Multicenter study on 471 patients with GCA who received TCZ therapy. Once complete remission was reached (n=231) TCZ was optimized in 125 patients. We compared patients in whom TCZ was optimized (TCZ_OPT group) or not (TCZ_NON-OPTgroup). Complete remission was defined as normalization of clinical and analytical (CRP and ESR) data. Optimization was done by decreasing the dose and/or prolonging the TCZ dosing interval progressively. We performed a comparison in effectiveness and safety parameters between optimized and non-optimized patients.

Results: We evaluated 231 GCA patients treated with TCZ with complete remission. No demographic or laboratory data differences was observed at TCZ onset between both groups (TABLE). The mean prednisone dose was higher in the TCZ_NON-OPT group at TCZ onset. The first TCZ optimization was performed after a median [25-75th] follow-up of 12 [6-17] months.

The median prednisone dose at first TCZ optimization was 2.5 [0-5] mg/day. At the end of follow-up prolonged remission was observed in 78.2% of TCZ_OPT group compared with 66.7% in the TCZ_NON-OPT group (p= 0.001) (FIGURE). Seven (5.6%) of the 125 optimized cases relapsed. Serious adverse events were similar in both groups, while serious infections were more frequent in the TCZ_NON-OPT group (p=0.009).

Conclusion: Once complete remission is reached in GCA patients under TCZ treatment, optimization of biologic may be performed. Based on our experience it could be performed by reducing the dose or by prolonging dosing interval of TCZ. It seems to be an effective and safe practice.

TABLE 1. Main general features at TCZ onset of 231 GCA patients with prolonged remission.

FIGURE. Mean prolonged remission

Disclosures: F. Benavides Villanueva, None; C. Corrales, None; J. Loricera, Novartis, UCB, Celgene, Roche; M. Calderón-Goercke, None; C. Moriano, None; S. Castañeda, Roche; F. NARVAEZ, None; V. Aldasoro, None; O. Maiz, None; R. Melero, None; J. Villa, None; P. Vela-Casampere, None; S. Romero Yuste, Pfizer, Lilly, AbbVie, Biogen, Sanofi; J. Callejas, None; E. De Miguel, None; E. Galíndez-Agirregoikoa, None; F. Sivera, None; J. Fernández-López, None; C. Galisteo, None; I. Ferraz Amaro, AbbVie/Abbott, Merck/MSD, Janssen, Roche, AbbVie/Abbott, Pfizer, Roche, Amgen, Celgene, Merck/MSD; J. SANCHEZ MARTIN, None; L. Sánchez-Bilbao, Eli Lilly; J. Hernández, None; M. Gonzalez Gay, None; R. Blanco, Eli Lilly, Pfizer, Roche, Janssen, MSD, AbbVie, Amgen, AstraZeneca, Bristol Myers Squibb, Galapagos, Novartis, Sanofi.

To cite this abstract in AMA style:

Benavides Villanueva F, Corrales C, Loricera J, Calderón-Goercke M, Moriano C, Castañeda S, NARVAEZ F, Aldasoro V, Maiz O, Melero R, Villa J, Vela-Casampere P, Romero Yuste S, Callejas J, De Miguel E, Galíndez-Agirregoikoa E, Sivera F, Fernández-López J, Galisteo C, Ferraz Amaro I, SANCHEZ MARTIN J, Sánchez-Bilbao L, Hernández J, Gonzalez Gay M, Blanco R. Utility of Optimization of Tocilizumab Therapy in Giant Cell Arteritis: A Multicenter Study of 471 Patients [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/utility-of-optimization-of-tocilizumab-therapy-in-giant-cell-arteritis-a-multicenter-study-of-471-patients/. Accessed .

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