Tocilizumab in Giant Cell Arteritis: A Real-Life Retrospective Study

Abstract

This study aims to evaluate (1) the efficacy and safety of tocilizumab (TCZ) as a steroid-sparing agent in patients with giant cell arteritis (GCA) and (2) the usefulness of F-fluorodeoxyglucose positron emission tomography (FDG-PET) in the follow-up and to detect disease activity. We retrospectively evaluated 12 patients with GCA treated with TCZ (8 mg/kg/mo). Pre- and posttherapy data about clinical signs and symptoms, laboratory results, FDG-PET imaging study, and the mean glucocorticoid (GC) dose were used to assess disease activity. Tocilizumab achieved complete disease remission in all patients. Mean FDG-PET-detected standard uptake value decreased from 2.05 ± 0.64 to 1.78 ± 0.45 ( P = .005). In 2 patients in whom temporal arteries color Doppler sonography examination was consistent with temporal arteritis, the hypoechoic halo disappeared after TCZ treatment. Mean GC dose was tapered from 26.6 ± 13.4 mg/d to 3.3 ± 3.1 mg/d ( P< .0001). One-half of the patients discontinued GC therapy. Three patients experienced severe adverse reactions and had to stop TCZ therapy. In accordance with previous reports, TCZ is an effective steroid-sparing agent for GCA, although careful monitoring of adverse drug reactions is needed. F-fluorodeoxyglucose positron emission tomography could be used to monitor disease activity in TCZ-treated patients, but prospective studies are needed to confirm these data.

Temporal ultrasound for monitoring tocilizumab treatment in giant cell arteritis: seeing beyond serum markers?

“…Τhe experience about temporal US in cranial GCA patients treated with TCZ is limited. Vitiello et al reported two cases in which initiation of TCZ treatment led to disappearance of ‘halo sign’ in the temporal US 4. In our clinic, TCZ resulted in significant amelioration of vessel wall inflammation in two cases.…”

Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis

“…A further 42 articles were excluded following fulltext assessment. Eventually, 21 studies were selected for the qualitative analysis (systematic review) [16,17,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Eight studies were included in the meta-analysis since these reports contained sufficient data to either evaluate the accuracy of [18F]FDG-PET/CT for discriminating between active disease and remission during treatment [19,23,25,33] or to evaluate the proportion of patients in which the scan normalized during clinical remission in patients on treatment [17,20,22,36].…”

<p>Giant cell arteritis: early diagnosis is key</p>

“…Few studies have examined FDG PET/CT as a potential imaging modality to monitor GCA disease activity in patients treated with corticosteroid-sparing therapies, such as anti-TNF and TCZ. In their retrospective study of 12 GCA patients treated with TCZ, Vitiello et al26 evaluated the value of FDG PET/CT in detecting and monitoring GCA disease activity. While patients were under low-dose corticosteroid therapy, a statistically significant reduction in FDG uptake was found, suggesting that FDG PET/CT may have the potential to monitor treatment response in TCZ-treated patients 26.…”

“…In their retrospective study of 12 GCA patients treated with TCZ, Vitiello et al26 evaluated the value of FDG PET/CT in detecting and monitoring GCA disease activity. While patients were under low-dose corticosteroid therapy, a statistically significant reduction in FDG uptake was found, suggesting that FDG PET/CT may have the potential to monitor treatment response in TCZ-treated patients 26. Although the use of FDG PET/CT has promising implications, further prospective studies with larger sample sizes are required to determine the clinical significance of FDG PET/CT in the diagnosis and management of GCA.…”