315. Effectiveness of every-other-week tocilizumab maintenance therapy in giant cell arteritis: a prospective single-centre study.
Creators: name: Alessano Tomelleri1
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background/objectives</strong>: Optimal duration of tocilizumab (TCZ) therapy in patients with giant cell arteritis (GCA) is yet to be defined. The GiACTA open-label extension phase showed that 58% of patients treated with a 12-month course of weekly TCZ had a disease flare in the 2 years following therapy suspension<sup>1</sup>. Our aim is to evaluate the efficacy and safety of low-dose TCZ maintenance in patients who achieved remission after one year of standard therapy. <strong>Methods:</strong> GCA patients eligible for TCZ according to the 2018 EULAR recommendations<sup>2 </sup>and who achieved remission after one year of weekly subcutaneous TCZ were prospectively enrolled. TCZ was administered every-other-week (EOW) for additional 12 months, and eventually suspended. Patients were evaluated 4-monthly during TCZ therapy, and 1 and 6 months after TCZ suspension. In patients with large-vessel (LV) involvement at baseline, PET scan was performed 12 and 24 months after TCZ start. The primary outcome was relapse-free survival at month 6 since TCZ suspension. Relapse-free survival during TCZ therapy and imaging response at PET scan were also evaluated. Adverse events were recorded. <strong>Results:</strong> 17 patients were enrolled (12 women, 71%; mean age 71.5±8.7 years). Disease features at diagnosis and TCZ start are listed in Table 1. Reasons for TCZ start were clinical or imaging disease flare (n=9), persistence of disease activity (n=5), and steroid-related adverse events (n=3). At TCZ start, median disease duration was 8 (3-22) months, serum C-reactive protein (CRP) was 13 (6-22) mg/L, daily prednisone (PDN) dose was 25 (15-37.5) mg; 4 patients were already on methotrexate (MTX) which was maintained in 1 of them. Ten patients had LV involvement on PET scan. At TCZ EOW start, no patient was on PDN and 1 patient was on MTX; MTX was added in another patient due to persistence of LV involvement on PET scan. All patients completed the 24-month TCZ course. Two patients (12%) had a polymyalgic flare while on EOW TCZ: one patient at month 1 and one patient at month 6; of note, one of them had a polymyalgic flare also while on weekly TCZ. Both flares were managed with a PDN course with complete clinical remission. No patient had active LV involvement at 24-month PET scan. Adverse events on EOW TCZ were zoster reactivation (n=1) and neutropenia (n=1). At TCZ stop, no patient was on PDN and 2 patients were on MTX. One month after TCZ stop, all patients were in remission. Six months after TCZ stop, 4 patients (24%) experienced a flare, which was successfully managed in all cases with TCZ weekly re-introduction; in 2 patients, a PDN course was also started. <strong>Conclusions:</strong> In this proof-of-concept study, low-dose TCZ maintenance in GCA showed excellent disease control, which was maintained in most patients after therapy suspension. Longer follow-up and replication in larger cohorts are required. <strong>Disclosures</strong>. AT, SS, LM: none; CC, EB, LD received consultation honoraria from Roche <strong>References.</strong> 1.Hellmich B et al. <em>Ann Rheum Dis</em>. 2020 2.Stone JH et al. <em>Lancet Rheumatol</em>. 2021