OP0064 TOCILIZUMAB IN CRANIAL AND EXTRACRANIAL REFRACTORY GIANT CELL ARTERITIS: A MULTICENTER STUDY OF 312 CASES
Authors: L. Sanchez-Bilbao, J. Loricera, V. Aldasoro, J. P. Valdivieso-Achá, I. Villa-Blanco, O. Maiz, R. Melero, C. Moriano, J. Sánchez, E. De Miguel, E. Perez-Pampín, J. R. De Dios, J. C. Nieto González, E. Galíndez-Agirregoikoa, P. Moya, F. Sivera, J. L. Andréu Sánchez, V. Pinillos, A. García-Valle, P. Vela-Casasempere, N. Alvarez-Rivas, M. Revenga, S. Manrique Arija, C. Fernández-López, E. Raya, C. Hidalgo, R. López-González, C. Campos Fernández, A. Juan-Mas, B. Arca, I. Rua-Figueroa, M. D. Boquet, A. García, A. Gallego, E. Salgado-Pérez, M. A. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2021)

Background: Giant cell arteritis (GCA) may be divided into cranial, and extracranial GCA. Tocilizumab (TCZ) has shown efficacy and safety in GCA and other large-vessel vasculitis (LVV) (1-5). Objectives: To compare the efficacy of TCZ in cranial and extracranial GCA. Methods: Multicenter observational study of 312 patients with GCA treated with TCZ. They were divided into 3 groups a) only cranial (cGCA), b) only extracranial (ecGCA), c) mixed affection (mixGCA). GCA was diagnosed by a) ACR criteria, and/or b) positive temporal artery biopsy, and/or c) LVV by imaging. Remission and sustained remission was defined according to EULAR definitions (1). In ecGCA and mixGCA we also studied the improvement (complete or partial) by imaging techniques. Results: We studied 312 patients (218 females; mean age, 73.4±9.6 years). TABLE shows the main features of the 3 groups. Remission at month 6 was higher in cGCA, as well as the sustained remission at month12 (FIGURE). At 18 and 24months, were similar in the 3 groups. Improvement by imaging techniques was partial/complete at 6,12,18 and 24 months, in 50%/0%,71%/0%, 61%/15% and 67%/17% respectively, in ecGCA, and in 75%/0%,53%/18%, 64%/12% and 50%/28% in mixGCA. Table 1. Main features of 312 patients at TCZ onset. Cranial GCA (n=152 ) Extracranial GCA (n=49 ) Mixed GCA (n=111 ) Cranial vs Extracranial GCA p Age at TCZ onset, years, mean± SD 76.0±8.2 65.4±12.2 73.5±8.1 0.000* Sex, female/male, n (% female ) 105/47 (69) 33/16 (67) 80/31 (72) 0.960 Time from diagnosis to TCZ onset (months, median [IQR] 6 [2-21] 7 [2-20] 9 [3-25] 0.765 Biopsy-proven GCA, n (% ) 87/128 (68) 0 (0) 50/87 (57) 0.000* Systemic manifestations at TCZ onset 109 (72) 32 (65) 84 (76) 0.501 Fever, n (%) 18 (12) 1 (2) 8 (7) 0.048* Constitutional syndrome, n (%) 52 (34) 16 (33) 47 (42) 0.933 PmR, n (%) 88 (58) 29 (59) 71 (64) 0.999 Ischemic manifestations at TCZ onset 117 (77) 0 (0) 70 (63) 0.000* Visual involvement, n (%) 31 (20) 0 (0) 16 (14) 0.000* Headache, n (%) 103 (85) 0 (0) 63 (57) 0.000* Jaw claudication, n (%) 39 (26) 0 (0) 21 (19) 0.000* Acute phase reactants ESR, mm/1 st hour, median [IQR] 28 [9-53] 24 [10-43] 28 [15-48] 0.462 CRP, mg/dL, median [IQR] 1.2 [0.3-3.4] 0.7 [0.4-1.8] 1.6 [0.4-3.8] 0.153 Prednisone dose at TCZ onset, mean ± SD 26.2±17.6 15.4±14.2 20.1±14.9 0.000* TCZmono/TCZcombo, n (% TCZ mono ) 116/36 (76) 26/23 (53) 69/42 (62) 0.003* Follow-up (months), mean ± SD 27.3±21.1 32.7±23.3 27.9±22.0 0.143 Figure 1. Remission and sustained remission of cGCA, ecGCA and mixGCA according to EULAR (1). I n the first 3 months we only could assess cGCA because in ecGCA and mixGCA a control imaging was not performed Conclusion: TCZ seems to be effective in all phenotypes but it is faster in cGCA in reaching remission. However, improvement by imaging techniques was partial and very rarely complete in ecGCA and mixGCA. References: [1]Hellmich B, et al. Ann Rheum Dis. 2020; 79: 19-30. [2]Stone JH, et al. N Engl J Med. 2017; 377: 317-28. [3]Calderón-Goercke M, et al. Semin Arthritis Rheum 2019; 49:126-35. https://doi.org/10.1016/j.semarthrit.2019.01.003 . [4]Prieto Peña D et al. Clin Exp Rheumatol 2020 Nov 27. PMID: 33253103. [5]Loricera J, et al. Clin Exp Rheumatol 2016; 34:S44-53. PMID: 27050507 Disclosure of Interests: Lara Sanchez-Bilbao: None declared, Javier Loricera: None declared, Vicente Aldasoro: None declared, Juan Pablo Valdivieso-Achá: None declared, Ignacio Villa-Blanco: None declared, Olga Maiz: None declared, Rafael Melero: None declared, Clara Moriano: None declared, Julio Sánchez: None declared, Eugenio de Miguel: None declared, Eva Perez-Pampín: None declared, Juan Ramón De Dios: None declared, Juan Carlos Nieto González: None declared, Eva Galíndez-Agirregoikoa: None declared, Patricia Moya: None declared, Francisca Sivera: None declared, José Luis Andréu Sánchez: None declared, Valvanera Pinillos: None declared, Andrea García-Valle: None declared, Paloma Vela-Casasempere: None declared, Noelia Alvarez-Rivas: None declared, Marcelino Revenga: None declared, Sara Manrique Arija: None declared, Carlos Fernández-López: None declared, Enrique Raya: None declared, Cristina Hidalgo: None declared, Ruth López-González: None declared, Cristina Campos Fernández: None declared, Antonio Juan-Mas: None declared, Beatriz Arca: None declared, Iñigo Rua-Figueroa: None declared, María Dolors Boquet: None declared, Antonio García: None declared, Adela Gallego: None declared, Eva Salgado-Pérez: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Grant/research support from: Abbvie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Grant/research support from: Abbvie, MSD and Roche