THU0321 CLINICAL OUTCOMES OF PATIENTS WITH GIANT CELL ARTERITIS AND POLYMYALGIA RHEUMATICA SYMPTOMS TREATED WITH TOCILIZUMAB IN ROUTINE CLINICAL PRACTICE
Authors: Sebastian Unizony, Robert Spiera, Jinglan Pei, Paris Sidiropoulos, Jennie H. Best, John H. Stone
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Approximately 50% of patients with giant cell arteritis (GCA) also have polymyalgia rheumatica (PMR) symptoms.<sup>1</sup> <h3>Objectives</h3> To determine whether the presence of PMR symptoms upon GCA diagnosis impacts GCA clinical outcomes and to evaluate the effectiveness of tocilizumab (TCZ) for controlling PMR symptoms in patients with GCA. <h3>Methods</h3> Retrospective analysis of patients with GCA treated with TCZ at a single center (2010-2018). Disease flares, defined as re-appearance of clinical manifestations (eg, cranial or PMR signs or symptoms), were assessed among patients with or without PMR at the time of GCA diagnosis. PMR symptoms during disease flares were assessed before and after TCZ initiation. <h3>Results</h3> A total of 60 patients with GCA (71.7% female; mean age, 69.3 years) were followed for a mean (SD) of 2.3 (2.17) years. At diagnosis, 32 had PMR symptoms (2 patients with PMR symptoms only). <b>Table 1</b> shows baseline patient characteristics. Among patients with PMR at diagnosis, 75% (n = 24) had a total of 60 flares before TCZ initiation and 34.3% (n = 11) had a total of 23 flares after TCZ initiation (<b>Table 2</b>). Among 28 patients without PMR at diagnosis, 67.9% (n = 19) had a total of 42 flares before TCZ initiation and 25% (n = 7) had a total of 14 flares after TCZ initiation (<b>Table 2</b>). TCZ was associated with a significant reduction in the annual flare rate both in patients with PMR symptoms (<i>P</i> = 0.003) and without PMR symptoms (<i>P</i> = 0.03) at diagnosis (<b>Table 2</b>). Median time to flare was significantly longer after initiation of TCZ in patients with PMR symptoms (hazard ratio [HR] [95% CI]: 0.18 [0.06 to 0.53]; <i>P</i> = 0.002) and without PMR symptoms (HR [95% CI]: 0.21 [0.05 to 0.87]; <i>P</i> = 0.032) at diagnosis. Before TCZ initiation, PMR symptoms were observed in 55.9% of flares (57/102) occurring in 43 patients (71.1%). After TCZ initiation, PMR symptoms were observed in 56.8% of flares (21/37) occurring in 18 patients (30%). <h3>Conclusion</h3> TCZ improved clinical outcomes in patients with GCA regardless of the presence or absence of PMR symptoms at diagnosis. These real-world findings suggest that TCZ is also effective in patients with GCA who have symptoms of PMR. <h3>Reference</h3> [1] Buttgereit F, et al. JAMA. 2016;315(22):2442-2458. <h3>Disclosure of Interests</h3> Sebastian Unizony Grant/research support from: F. Hoffmann-La Roche, Genentech, Consultant for: Kiniksa, Sanofi, GSK, Robert Spiera Grant/research support from: Roche-Genentech, GlaxoSmithKline, Bristol-Myers Squibb, Boehringer Ingelheim, Cytori, Chemocentryx, Corbux, Consultant for: Roche-Genentech, GlaxoSmithKline, CSL Behring, Sanofi Aventis, Jinglan Pei Employee of: Genentech, Paris Sidiropoulos Employee of: Genentech, Jennie H. Best Shareholder of: Genentech, Employee of: Genentech, John H. Stone Grant/research support from: F. Hoffmann-La Roche, Genentech, Xencor, Consultant for: Chugain, F. Hoffmann-La Roche, Genentech, Xencor