Support for tocilizumab use in giant cell arteritis

A significant proportion of patients with giant cell arteritis (GCA) remission who discontinue tocilizumab treatment after 1 year remain in clinical remission for a further 2 years. This was demonstrated in a follow-up study from the double-blind, randomised GiACTA trial [1]. Additionally, restarting tocilizumab restores clinical remission among those patients who do experience disease flare. No new safety signals were observed.

In patients with GCA, the use of the interleukin-6 receptor inhibitor tocilizumab in combination with 26-week prednisone tapering resulted in higher rates of sustained glucocorticoid-free remission compared with placebo and prednisone tapering in week 52 of the GiACTA trial [2]. Dr John Stone (Massachusetts General Hospital, Boston, USA) et al. aimed to investigate longer-term efficacy and safety of tocilizumab in GCA patients in this 2-year long-term extension of the GiACTA trial.

Patients in clinical remission (n=127) at the end of the double-blind period were asked to stop tocilizumab treatment. Of these, 51 patients (40%) maintained clinical remission during the extension study. The median time to first flare was longer for patients who were originally treated compared with those originally on placebo. The results further showed that disease flares tended to be resolved more quickly in those who originally received tocilizumab treatment. Rates of serious adverse events per were comparable for patients who never received tocilizumab and those who did (23.1 vs 25.4 per 100 patient-years), and rates of serious infections were 4.6 and 3.5 per 100 patient-years, respectively.

1. Stone JH. et al. Abstract OP0140. EULAR 2019
2. Stone JH, et al. N Engl JMed. 2017 Jul 27;377(4):317-328.

Posted on 4 September 201917 March 2021