Optimisation of tocilizumab therapy in giant cell arteritis. A multicentre real-life study of 471 patients

New-onset aortitis manifesting as relapsing giant cell arteritis successfully managed with tocilizumab monotherapy. A comment on: Optimisation of tocilizumab therapy in giant cell arteritis. by Calderon-Goercke et al.

“…We read with interest the article by Calderon-Goercke et al describing their experience with tocilizumab optimisation in patients with giant cell arteritis (GCA) (1). The findings from this study are noteworthy showing ongoing clinical effectiveness combined with improved safety through reduction in severe infections among patients undergoing dose optimisation (1). Optimal dose and duration of tocilizumab therapy in patients with GCA is largely unknown given the clinical trial data is limited to 12 months (2,3).…”

Tocilizumab for giant cell arteritis: what is optimal?

“…Indeed, the findings of the Calderón-Goercke study suggest that for patients in remission after 12 months of treatment, a tocilizumab dose reduction appears to maintain most patients in remission, is safe and cost effective. However, the reported treatment discontinuation rate was low (less than 20%) and longer term outcomes remain to be determined (13). The real-world efficacy of tocilizumab was also confirmed in a cohort of 114 patients from the USA (14).…”

“…The few reported cases of vision loss in tocilizumab-treated patients occurred early in the disease course during induction of therapy rather than during the maintenance treatment phase (16). Moreover, in the studies utilising a tapering dose of tocilizumab, no new cases of vision loss were reported (13,15). On the other hand, a treatment course of tocilizumab with only a 3-day regimen of glucocorticoids may be inadequate.…”

“…Additionally, risk factors for relapse after tocilizumab discontinuation are largely unknown. In this regard, in this issue, Calderón-Goercke et al from Spain reported the real-world outcomes of the largest GCA cohort to date, comprised of 471 patients, of whom 231 were in prolonged remission after a median 12 months of tocilizumab therapy (13). Patients in remission were then treated with either optimised (by decreasing the dose or increasing the interval) or non-optimised (by continuing the standard dose) tocilizumab regimens for approximately two years.…”

Giant Cell Arteritis: State of the Art in Diagnosis, Monitoring, and Treatment

“…Interestingly, despite clinical differences between real-life patients undergoing TCZ treatment and those included in the GiACTA trial (real-life patients were older with longer disease duration and higher values of erythrocyte sedimentation rate (ESR), TCZ was equally effective in both GiACTA trial and clinical practice patients. 84 …”