Utility of Tocilizumab in Visual Affection of Patients with Giant Cell Arteritis

Monica Calderón Goercke¹, Javier Loricera², Diana Prieto Peña¹, Clara Moriano Morales³, Elvira Diez Alvarez⁴, Francisco Javier Narváez⁵, Antonio Mera⁶, Eva Perez Pampín⁶, Vicente Aldasoro⁷, María Varela-García⁸, Noelia Álvarez-Rivas⁹, Ceferino Barbazan¹⁰, Carmen Ordas-Calvo¹¹, Francisca Sivera¹², Cristina Luna Gómez¹³, Francisco J. Toyos Sáenz de Miera¹⁴, Arantxa Conesa¹⁵, Francisco Navarro¹⁶, Belén Atienza-Mateo¹⁷, José Luis Martín-Varillas¹⁷, Eva Galindez-Agirregoikoa¹⁸, Vanesa Calvo-Río¹⁷, Carmen González-Vela¹⁹, Natalia Palmou-Fontana², José Luis Hernández², Miguel Angel González-Gay² and Ricardo Blanco¹⁷, ¹Rheumatology, Rheumatology. Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ²Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ³Rheumatology, Complejo Asistencial Universitario de León. León. Spain, León, Spain, ⁴Complejo Asistencial Universitario de León, León, Spain, ⁵Rheumatology Department, Hospital Universitario de Bellvitge, Idibell, Barcelona, Spain, ⁶Rheumatology Division. Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain, ⁷Hospital Alto Deba. Mondragón. Spain, Mondragon, Spain, ⁸Complejo Hospitalario de Navarra, Navarra, Spain, ⁹Hospital Universitario Lucus Augusti, Lugo. Spain, Lugo, Spain, ¹⁰Complexo Hospitalario Universitario de Vigo, Vigo. Spain, Vigo, Spain, ¹¹Hospital Cabueñes, Gijón. Spain, Gijón, Spain, ¹²Rheumatology, Hospital General Universitario de Elda. Comunidad Valenciana. Spain, Elda, Spain, ¹³Rheumatology, University Hospital Ntra. Sra. de La Candelaria, Santa Cruz de Tenerife, Spain, ¹⁴Hospital Virgen de La Macarena. Sevilla. Spain, Sevilla, Spain, ¹⁵Rheumatology, Hospital Clínico Universitario de Valencia. Spain, Valencia, Spain, ¹⁶Hospital General Universitario de Elche, Alicante. Spain, Alicante, Spain, ¹⁷Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ¹⁸Rheumatology, University Hospital of Basurto, Bilbao, Spain, ¹⁹Pathology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: giant cell arteritis, ocular involvement and tocilizumab

Session Information

Date: Tuesday, October 23, 2018

Title: Vasculitis Poster III: Immunosuppressive Therapy in Giant Cell Arteritis and Polymyalgia Rheumatica

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Giant cell arteritis (GCA) is a large vessel vasculitis with a special predilection for extracranial branches of the external carotid artery. Among its most fearsome complications is visual affectation. Tocilizumab (TCZ) is a monoclonal antibody directed against the interleukin 6 receptor that has shown utility in the treatment of GCA. Our aim was to assess the evolution of visual clinic in patients with GCA treated with TCZ.

Methods: Retrospective multicenter study on 20 GCA patients with visual involvement in treatment with TCZ. The efficacy of this drug on visual symptoms was evaluated.

Results: We assessed 20 patients (14 women and 6 men) with a mean age ± SD of 73.7 ± 10.1 years with GCA and visual symptoms. In total there were 23 affected eyes. The symptoms reported were: unilateral blindness (n = 6), unilateral blurred vision (n = 6), unilateral amaurosis fugax (n = 3), unilateral hemianopsia (n = 2), bilateral blindness (n = 1), bilateral blurred vision (n = 1), bilateral hemianopsia (n = 1). Before starting treatment with TCZ, all patients had received high doses of prednisone, with a mean ± SD dose of 54.2 ± 13.8 mg / day (range of doses: 40-80 mg / day). In addition, 9 of them also received intravenous corticosteroid boluses. In addition, 13 patients received traditional immunosuppressants: methotrexate (MTX) (n= 12), cyclophosphamide (n = 2), leflunomide (n = 1) and azathioprine (n = 1). Regardless of corticosteroids, TCZ was administered as monotherapy in 14 patients, while in 6 it was administered in combination with MTX. The TABLE shows the evolution of the visual affectation of these patients. Throughout a median follow-up [RIC] of 9 [4-18] months, none of the 7 patients who had a blindness regained vision. The 2 patients who presented unilateral hemianopsia recovered vision. The patient with bilateral hemianopsia and the patient with bilateral blurred vision experienced a partial improvement. The remaining patients achieved a complete recovery.

Conclusion: Although TCZ seems to be also useful in the treatment of visual manifestations of ACG, once blindness is established, it does not seem to be effective.

	Month 1 n=20	Month 3 n=14	Month 6 n=10	Month 12 n=5
Visual improvement after starting TCZ, n (%)
Complete improvement	6 (30)	5 (35.7)	5 (50)	1 (25)
Partial improvement	2 (10)	3 (21.4)	0 (0)	0 (0)
No improvement	12 (60)	6 (42.8)	5 (50)	5 (50)

Disclosure: M. Calderón Goercke, None; J. Loricera, None; D. Prieto Peña, None; C. Moriano Morales, None; E. Diez Alvarez, None; F. J. Narváez, None; A. Mera, None; E. Perez Pampín, None; V. Aldasoro, None; M. Varela-García, None; N. Álvarez-Rivas, None; C. Barbazan, None; C. Ordas-Calvo, None; F. Sivera, None; C. Luna Gómez, None; F. J. Toyos Sáenz de Miera, None; A. Conesa, None; F. Navarro, None; B. Atienza-Mateo, None; J. L. Martín-Varillas, None; E. Galindez-Agirregoikoa, None; V. Calvo-Río, None; C. González-Vela, None; N. Palmou-Fontana, None; J. L. Hernández, None; M. A. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Calderón Goercke M, Loricera J, Prieto Peña D, Moriano Morales C, Diez Alvarez E, Narváez FJ, Mera A, Perez Pampín E, Aldasoro V, Varela-García M, Álvarez-Rivas N, Barbazan C, Ordas-Calvo C, Sivera F, Luna Gómez C, Toyos Sáenz de Miera FJ, Conesa A, Navarro F, Atienza-Mateo B, Martín-Varillas JL, Galindez-Agirregoikoa E, Calvo-Río V, González-Vela C, Palmou-Fontana N, Hernández JL, González-Gay MA, Blanco R. Utility of Tocilizumab in Visual Affection of Patients with Giant Cell Arteritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/utility-of-tocilizumab-in-visual-affection-of-patients-with-giant-cell-arteritis/. Accessed .

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