OP0033 OPTIMIZATION OF TOCILIZUMAB THERAPY IN GIANT CELL ARTERITIS. A MULTICENTER REAL-LIFE STUDY OF 134 PATIENTS
Authors: M. Calderón-Goercke, D. Prieto-Peña, S. Castañeda, C. Moriano, E. Becerra-Fernández, M. Revenga, N. Alvarez-Rivas, C. Galisteo, Á. Prior-Español, E. Galindez, C. Hidalgo, S. Manrique Arija, E. De Miguel, E. Salgado-Pérez, V. Aldasoro, I. Villa-Blanco, S. Romero-Yuste, J. Narváez, C. Gomez-Arango, E. Perez-Pampín, R. Melero, F. Sivera, A. Olive, M. Álvarez del Buergo, L. Marena Rojas, C. Fernández-López, F. Navarro, E. Raya, B. Arca, R. Solans-Laqué, A. Conesa, C. Vázquez, J. A. Román-Ivorra, P. Lluch, P. Vela-Casasempere, C. Torres-Martín, J. C. Nieto, C. Ordas-Calvo, C. Luna-Gomez, F. J. Toyos Sáenz de Miera, N. Fernández-Llanio, A. García, J. L. Hernández, M. A. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2020)

Background: Tocilizumab (TCZ) is the only biological agent approved in Giant Cell Arteritis (GCA). There is general agreement on the initial and the standard maintenance dose of TCZ. However, information on duration and optimization of TCZ in GCA is scarce. Objectives: Our aim was to assess efficacy and safety of TCZ therapy optimization in an unselected wide series of GCA in clinical practice. Methods: Multicenter study, 134 patients with GCA who received TCZ due to inefficacy/adverse events of previous therapy. Once complete remission was reached and based on a shared decision between patient and physician TCZ was optimized in some cases. Optimization was done by decreasing the dose and/or prolonging the TCZ dosing interval progressively. Results: 134 GCA patients treated with TCZ (101w/33m); mean age 73.0±8.8 years. TCZ was administered IV to 106 (79.1%) patients and SC to 28 (20.9%). TCZ was optimized in 43 (32.1%) patients. No demographic, clinical manifestations or laboratory data differences had been found at TCZ onset (TABLE). After a follow up of 12 [6-15.5] months, and a complete remission for 6 [3-12] months; the first TCZ optimization was performed. Median prednisone dose at first TCZ optimization was 2.5 [0-5] mg/day. TCZ IV was optimized from 8 to 4 mg/kg/4weeks in 12 of 106 (11.3%) and from 162 mg/SC/week to 162 mg/SC/2weeks in 9 of 28 (32.1%) cases. Five (11.6%) of the 43 optimized cases relapsed. In 4 cases, the relapses were treated increasing TCZ up to the pre-optimization dose, in 1 case the route of administration was change (4 mg/kg/4week to 162 mg/SC/week). In 8 of 43 optimized patients (18.6%), it was possible to withdraw TCZ after complete remission for 30 [16.25-45.75] months. Regarding adverse events and severe infections were similar in both groups. The mean TCZ treatment costs were lower in the optimized group. Conclusion: Once remission is reached in GCA patients under TCZ treatment, optimization of TCZ may be performed. Based on our experience it could be performed by reducing the dose with IV TCZ or by prolonging dosing interval with SC TCZ. References: [1]Calderón-Goercke M et al. Semin Arthritis Rheum 2019 Aug;49(1): 126-135. TABLE. OPTIMIZED-TCZ GROUP (n=43 ) NON-OPTIMIZED TCZ GROUP (n=91 ) p BASAL FEATURES AT TCZ ONSET GENERAL FEATURES Age, years, mean± SD 68.9±8.7 71.4±8.5 0.125 Sex, female/male n(%) 32/10 68/24 0.779 Time from GCA diagnosis to TCZ onset (months), median [IQR] 19.5[7.75-45] 10.5[4 – 25] 0.047 SYSTEMIC MANIFESTATIONS Fever, n(%) 1(2.4) 8(8.7) 0.176 Constitutional syndrome, n(%) 11(26.2) 19(20.7) 0.476 PMR, n(%) 18(42.9) 56(60.9) 0.052 ISCHEMIC MANIFESTATIONS Visual involvement, n(%) 5(11.9) 23(25) 0.084 Headache, n(%) 26(61.9) 42(45.7) 0.081 Jaw claudication, n(%) 1(2.4) 11(12) 0.072 CORTICOSTEROIDS AT TCZ ONSET Prednisone dose, mg/d mean (SD) 15.1±11.1 25±17.4 0.001 FOLLOW-UP ON TCZ THERAPY (MONTHS), MEDIAN [IQR] 24[18-27] 6 [3-18] 0.000 Relapses, n(%) 5(11.6) 5(5.5) 0.207 End follow-up remission, n(%) 40(93) 84(92) 0.99 Severe side efects, n(%) 14(32.6) 22(24.2) 0.307 Seriuos infections, n(%) 6(14) 10(11) 0.878 Cost, (mean) euros per year IV SC 7 538.4 7 329.0 11 726.4 11 726.4 - - Disclosure of Interests: Monica Calderón-Goercke: None declared, D. Prieto-Peña: None declared, Santos Castañeda: None declared, Clara Moriano: None declared, Elena Becerra-Fernández: None declared, Marcelino Revenga: None declared, Noelia Alvarez-Rivas: None declared, Carles Galisteo: None declared, Águeda Prior-Español: None declared, E. Galindez: None declared, Cristina Hidalgo: None declared, Sara Manrique Arija: None declared, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Eva Salgado-Pérez: None declared, Vicente Aldasoro Speakers bureau: Roche, Abbvie, MSD, UCB, Pfizer, Menarini, Grunenthal, Gebro, Novartis, Janssen, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Susana Romero-Yuste: None declared, J. Narváez: None declared, Catalina Gomez-Arango: None declared, Eva Perez-Pampín: None declared, Rafael Melero: None declared, Francisca Sivera: None declared, Alejandro Olive: None declared, María Álvarez del Buergo: None declared, Luisa Marena Rojas: None declared, Carlos Fernández-López: None declared, Francisco Navarro: None declared, Enrique Raya: None declared, Beatriz Arca: None declared, Roser Solans-Laqué: None declared, Arantxa Conesa: None declared, Carlos Vázquez: None declared, Jose Andrés Román-Ivorra: None declared, Pau Lluch: None declared, Paloma Vela-Casasempere: None declared, Carmen Torres-Martín: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Carmen Ordas-Calvo: None declared, Cristina Luna-Gomez: None declared, Francisco J. Toyos Sáenz de Miera: None declared, Nagore Fernández-Llanio: None declared, Antonio García: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD