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Relapse after cessation of weekly tocilizumab for giant cell arteritis: a multicentre service evaluation in England

2023; Oxford University Press; Volume: 63; Issue: 12 Linguagem: Inglês

10.1093/rheumatology/kead604

1462-0332

Vanessa Quick, Mahdi Abusalameh, Sajeel Ahmed, Hoda Alkoky, Marwan Bukhari, Stuart Carter, Fiona Coath, Brian Davidson, Parveen Doddamani, Shirish Dubey, Georgina Ducker, Bridget Griffiths, Nicola Gullick, Jonathan Heaney, Amelia Holloway, Ei Ei Phyu Htut, Mark Hughes, Hannah Irvine, Alison Kinder, Asim Kurshid, Joyce Lim, Dalia Ludwig, Mariam Elmegaard Malik, Louise Mercer, Ben Mulhearn, Jagdish Nair, Rikesh Patel, Joanna Robson, Pratyasha Saha, Sarah Tansley, Saad Ahmed, I. Atchia, James Bluett, Alex Connew, Elizabeth J. Coulson, Helena Crawshaw, Ursula Davies, Denise De Lord, Gurdeep Dulay, A. Embuldeniya, Carmen Fonseca, James Galloway, William Gubbins, Thushyanthan Guruparan, Rebecca Heaton, Martin James, Shalini Janagan, Hilary Johnson, Areej Karim, Salema Khalid, K. Kinsey, Gouri Koduri, Stuart M. Linton, Elizabeth MacPhie, Arti Mahto, Chetan Mukhtyar, Anupama Nandagudi, P. K. Nandi, F. Ben Osman, Sophie Plumb, Eavan Quinlan, Angela Redfern, Marian Regan, Vanessa Reid, Dipak Roy, Sadaf Saeed, A. C. H. Smith, Lauren Steel, Rhys Thomas, Adaeze Ugwoke, Sarah Villar, Emma L. Williams, Fiona Wood, Mingrui Xie, Sarah Mackie,

Sarcoidosis and Beryllium Toxicity Research

Abstract Objectives The National Health Service in England funds 12 months of weekly s.c. tocilizumab (qwTCZ) for patients with relapsing or refractory GCA. During the coronavirus disease 2019 (COVID-19) pandemic, some patients were allowed longer treatment. We sought to describe what happened to patients after cessation of qwTCZ. Methods Multicentre service evaluation of relapse after stopping qwTCZ for GCA. The log-rank test was used to identify significant differences in time to relapse. Results A total of 336 GCA patients were analysed from 40 centres, treated with qwTCZ for a median [interquartile range (IQR)] of 12 (12–17) months. At time of stopping qwTCZ, median (IQR) prednisolone dose was 2 (0–5) mg/day. By 6, 12 and 24 months after stopping qwTCZ, 21.4%, 35.4% and 48.6%, respectively, had relapsed, requiring an increase in prednisolone dose to a median (IQR) of 20 (10–40) mg/day. 33.6% relapsers had a major relapse as defined by EULAR. Time to relapse was shorter in those that had previously also relapsed during qwTCZ treatment (P = 0.0017), in those not in remission at qwTCZ cessation (P = 0.0036) and in those with large vessel involvement on imaging (P = 0.0296). Age ≥65 years, gender, GCA-related sight loss, qwTCZ treatment duration, TCZ taper, prednisolone dosing and conventional synthetic DMARD use were not associated with time to relapse. Conclusion Up to half our patients with GCA relapsed after stopping qwTCZ, often requiring a substantial increase in prednisolone dose. One-third of relapsers had a major relapse. Extended use of TCZ or repeat treatment for relapse should be considered for these patients.