AB0620 EFFICACY AND SAFETY OF TOCILIZUMAB IN GIANT CELL ARTERITIS: A MONOCENTRIC REAL-LIFE EXPERIENCE
Authors: Alessandro Tomelleri, Corrado Campochiaro, Silvia Sartorelli, Adriana Cariddi, Elena Baldissera, Lorenzo Dagna
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Giant cell arteritis (GCA) is a large-vessel vasculitis that generally affects people older than 50 years<sup>1</sup>. Glucocorticoids are the mainstay treatment<sup>2</sup>. Tocilizumab (TCZ) has recently been shown in clinical trials to be effective and safe for the treatment of GCA<sup>3</sup>. <h3>Objectives</h3> To describe our real-life experience with TCZ in a cohort of GCA patients from a single Italian Centre. <h3>Methods</h3> We included GCA patients diagnosed according to the 1990 aCR criteria, followed-up at our Large Vessel Vasculitis Clinic, and treated with TCZ. We retrospectively evaluated demographic features, disease characteristics, reasons for TCZ introduction and discontinuation, concomitant therapies and response to treatment. For each patient we evaluated potential eligibility for GiACTA trial. For statistical comparisons, we used non-parametric tests. <h3>Results</h3> 40 patients (32 women, mean age 71±10 years) were included. Table 1 summarizes clinical features, tools for GCA diagnosis (imaging and/or biopsy) and reasons for TCZ introduction. Mean disease duration before TCZ introduction was 21.5±29.1 months. Only 12 patients (30%) met both GiACTA inclusion and exclusion criteria at TCZ introduction. 31 patients were followed-up for 3 months, 23 for 6 months, 17 for 12 months. Mean prednisone (PDN) dose at TCZ introduction was 21.9±13.2 mg. Mean PDN dose was 8.4±6.5 mg (p&lt;0.001) at month 3, 4.8±5.6 mg (p=0.002) at month 6 and 2.3±2.3 mg (p=0.012) at month 12. PDN was stopped in 9 patients (2 at month 3, 5 at month 6, 2 at month 12) due to optimal disease control with TCZ alone. At TCZ introduction, 7 patients were already on methotrexate (MTX). MTX was subsequently stopped in 2 patients (1 at month 3, 1 at month 6) due to disease control. TCZ was temporarily held-off in 2 patients due to zoster reactivation and in 2 patients due to mild infections. TCZ was definitively stopped after 2 months (when PDN dose was still high) in 2 patients due to severe infections and after 6 months in 1 patient due to diverticulitis. No patient experienced severe neutropenia or liver enzymes elevation. In no case, TCZ was judged inefficient. <h3>Conclusion</h3> Our data confirm TCZ is highly effective in GCA treatment and has a significant steroid-sparing effect. In our real-life retrospective study, TCZ was also shown to be a safe option in patients with relapsing or refractory GCA. <h3>References</h3> [1] Salvarani C., et al. Polymyalgia rheumatica and giant-cell arteritis. Lancet (2008) [2] Proven a., et al. Glucocorticoid therapy in giant cell arteritis. Arthritis Rheum (2003) [3] Stone JH, et al. Trial of Tocilizumab in Giant-Cell arteritis. N Engl J Med (2017) <h3>Disclosure of interests</h3> Alessandro Tomelleri: None declared, Corrado Campochiaro Consultant for: Dr Corrado Campochiaro received consultation honoraria from Pfizer., Silvia Sartorelli: None declared, adriana cariddi: None declared, Elena Baldissera Consultant for: Consultation honoraria from Novartis and Rottapharm, Speakers bureau: Pfeizer, Sobi, Novartis, Lorenzo Dagna Consultant for: Prof Lorenzo Dagna received consultation honoraria from abbvie, amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Sanofi-Genzyme, and SOBI.