Relapse after cessation of weekly tocilizumab for giant cell arteritis: a multicentre service evaluation in England
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Authors
Quick, V
Abusalameh, M
Ahmed, S
Alkoky, H
Bukhari, M
Carter, S
Coath, F.L
Davidson, B
Doddamani, P
Dubey, S
Issue Date
2023
Type
Scientific Paper
Language
Keywords
Research Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine::Rheumatology
Alternative Title
Abstract
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.
Graphical Abstract
Graphical Abstract
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giant cell arteritis, vasculitis, tocilizumab, NICE guidance, service evaluation, relapse
Topic: giant cell arteritisfollow-upprednisolonediagnostic imagingpandemicstocilizumabdisease remissionlarge blood vesselsnational health service (uk)
Issue Section: Concise Report
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Description
Citation
Vanessa Quick, Mahdi Abusalameh, Sajeel Ahmed, Hoda Alkoky, Marwan Bukhari, Stuart Carter, Fiona L 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 R Ludwig, Mariam Malik, Louise Mercer, Ben Mulhearn, Jagdish R Nair, Rikesh Patel, Joanna Robson, Pratyasha Saha, Sarah Tansley, TOC STOP 2022 Investigators , Sarah L Mackie, Relapse after cessation of weekly tocilizumab for giant cell arteritis: a multicentre service evaluation in England, Rheumatology, 2023;, kead604, https://doi.org/10.1093/rheumatology/kead604