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Tocilizumab in giant cell arteritis: Multicenter open-label study of 22 patients

Abstract: OBJECTIVE: To assess the efficacy of tocilizumab (TCZ) in giant cell arteritis (GCA) patients with refractory disease and/or with unacceptable side effects due to corticosteroids. METHODS: A retrospective multicenter open-label study on 22 GCA patients treated with TCZ at standard dose of 8mg/kg/month. The main outcomes were achievement of disease remission and reduction of corticosteroid dose. RESULTS: The mean age ± standard deviation of patients was 69 ± 8 years. The main clinical features at TCZ onset were polymyalgia rheumatica (n = 16), asthenia (n = 7), headache (n =5), constitutional symptoms (n = 4), jaw claudication (n = 2), and visual loss (n = 2). Besides corticosteroids and before TCZ onset, 19 of 22 patients had also received several conventional immunosuppressive and/or biologic drugs. Of 22 patients, 19 achieved rapid and maintained clinical improvement following TCZ therapy. Also, after a median follow-up of 9 (interquartile range: 6-19) months, the C-reactive protein level had fallen from 1.9 (1.2-5.4) to 0.2 (0.1-0.9)mg/dL (p < 0.0001) and the erythrocyte sedimentation rate decreased from 44 (20-81) to 12 (2-20)mm/1st hour (p = 0.001). The median dose of prednisone was also tapered from 18.75 (10-45) to 5 (2.5-10)mg/day (p < 0.0001). However, TCZ had to be discontinued in 3 patients due to severe neutropenia, recurrent pneumonia, and cytomegalovirus infection. Moreover, 1 patient died after the second infusion of TCZ due to a stroke in the setting of an infectious endocarditis. CONCLUSION: TCZ therapy leads to rapid and maintained improvement in patients with refractory GCA and/or with unacceptable side effects related to corticosteroids. However, the risk of infection should be kept in mind when using this drug in patients with GCA.

Otras publicaciones de la misma revista o congreso con autores/as de la Universidad de Cantabria

 Fuente: Semin Arthritis Rheum. 2015 Jun;44(6):717-23

Editorial: W.B. Saunders

 Año de publicación: 2015

Nº de páginas: 7

Tipo de publicación: Artículo de Revista

 DOI: 10.1016/j.semarthrit.2014.12.005

ISSN: 0049-0172,1532-866X

Proyecto español: RD08/ 0075 ; RD12/0009/0013

Autores/as

LORICERA, JAVIER

RICARDO BLANCO ALONSO

CASTAÑEDA, SANTOS

MERA, ANTONIO

PÉREZ PAMPÍN, EVA

PEIRÓ, ENRIQUETA

HUMBRÍA, ALICIA

CALVO ALÉN, JAIME

AURRECOECHEA, ELENA

NARVÁEZ, JAVIER

SÁNCHEZ ANDRADE, AMALIA

VELA, PALOMA

DÍEZ, ELVIRA

MATA, CRISTINA

LLUCH, PAU

MOLL, CONCEPCIÓN

PINA MURCIA, TRINITARIO