Successful use of tocilizumab in polymyalgic onset biopsy positive GCA with large vessel involvement

Abstract

A 63-year-old female presented with a 12-week history of worsening proximal pain and stiffness. She was diagnosed with polymyalgia rheumatica and started on corticosteroids. The authors were unable to wean-off her steroid treatment, despite trying various steroid sparing agents on different occasions with no benefit. In August 2010, she was diagnosed with giant cell arteritis with a temporal artery biopsy and ultrasound of the temporal and axillary arteries. An fluorine-18-deoxyglucose positron emission tomography CT showed increased uptake in the aorta and major vessels, in keeping with widespread large vessel involvement. Due to the disease severity, the failure of previous disease-modifying agents and the development of steroid related sideeffects, the authors decided to treat her with intravenous tocilizumab (TCZ;an interleukin 6 blocker). After her first infusion, the patient reported excellent response with normalisation of her inflammatory markers. Prednisolone reduced from 20 mg to 3.5 mg /day after five infusions of TCZ (8 mg/kg).

Successful Treatment of Giant Cell Arteritis with Tocilizumab: Report of 2 Cases with Review of the Literature

“…Some published reports showed the ability of TCZ to induce remission or to reduce glucocorticoids [7][8][9][10][11][12][13][14][15][16][17]55]. The tapering of corticoids to less than 7.5 mg/day was obtained after 3 to 8 months of treatment by TCZ in some reports [7,9,10,13,55]. Seitz et al [55] reported that prednisone dosage could be reduced within 3 months to a mean of 2.5 mg/day (range 0-10 mg/day) in 5 patients with GCA( two of them were newly diagnosed and not treated by corticoids before).…”

“…Tocilizumab (TCZ), an interleukin 6 receptor antibody, was considered, on the basis of pathogenic and pathologic data of GCA, as a potentially effective treatment for this disease .The drug showed efficacy in few case reports and small series [7][8][9][10][11][12][13][14][15][16][17]. Here we report 2 cases with Giant cell arteritis that was dependent to corticoids, successfully treated by TCZ.…”

Biologics in vasculitides: Where do we stand, where do we go from now?

“…Furthermore, serum IL-6 levels mirror the activity of the disease, and decline with effective GC therapy, suggesting a potential therapeutic role for the IL-6 receptors inhibitor monoclonal antibody tocilizumab (TCZ) [16]. Case reports and small case series have shown the efficacy of TCZ in the treatment of patients with relapsing/refractory GCA [17][18][19][20][21][22][23][24]. A smaller number of newly diagnosed GCA patients naive to GC and other immunosuppressive agents has also successfully been treated with TCZ monotherapy [18,25].…”

Giant cell arteritis: a review

“…Recently, treatment with the interleukin-6 inhibitor, tocilizumab, has been shown to be effective in patients with giant cell arteritis. [75][76][77] Tocilizumab is indicated in a subgroup of patients with giant cell arteritis and profound constitutional symptoms, a high systemic inflammatory response, and active disease, with involvement of the aorta and its main branches. Larger studies with this therapeutic agent are awaited.…”