AB1326 METHOTREXATE VERSUS TOCILIZUMAB IN MAINTAINING REMISSION: A RETROSPECTIVE MONOCENTRIC COHORT STUDY IN PATIENTS WITH GIANT CELL ARTERITIS
Authors: P. Rubortone, F. G. Lazzaro, F. Leone, M. R. Gigante, S. L. Bosello, A. Ortolan, M. A. D’ Agostino
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Nearly 50% of patients with giant cell arteritis (GCA) experience at least one relapse after achieving remission [1]; in some cases, these relapses may be potentially life-threatening. Currently, reliable predictors of relapse are lacking. Therefore, providing the best possible therapeutic option to minimize the risk of relapse is crucial. The two most used steroid-sparing drugs are Methotrexate (MTX) and Tocilizumab (TCZ). Only a few observational studies have compared the relative effectiveness and safety of these two drugs and the associated risk of relapse [2] <h3>Objectives:</h3> To evaluate frequency and predictors of relapse in a cohort of patients affected by Giant Cell Arteritis undergoing steroid-sparing therapy with MTX or TCZ. <h3>Methods:</h3> We conducted a retrospective analysis of clinical, demographic and laboratory data at disease onset on 41 patients with GCA who started therapy with MTX or TCZ within 6 months from diagnosis. We observed whether these patients experienced relapse at any time during a median follow-up time of 57.5 months. Remission was defined as the absence of clinical and laboratory signs of disease activity (according to EULAR recommendations [3]) and achievement of a steroid dose ≤7.5 mg/day of prednisone equivalent, to minimize the confounding impact of glucocorticoids on the effectiveness of DMARD therapy. Relapse was defined as the recurrence of active disease (major or minor, according to EULAR [3]) after achieving remission. Descriptive statistics, chi-square tests for categorical variables, and Mann-Whitney tests for continuous variables were conducted. A significance level of p &lt; 0.05 was considered. <h3>Results:</h3> At diagnosis, 31.7% (13/41) of patients had irreversible visual impairment and 10% (4/41) had cerebrovascular event. Extracranial involvement was present in 54% (22/41) of patients; 29% of patients were treated with steroid pulses, with an average duration of prednisone equivalent &gt;7.5mg/day of 23.7 ±20.7 months. Remission was achieved after a median time of 9 month. Within 6 months from diagnosis, 63% (26/41) of patients received MTX (average dose 13,75 mg/week, SD ±3,6) while 36 % (15/41) received TCZ. Comparing patients on MTX and on TCZ therapy, no significant differences were found in baseline inflammatory markers, average DMARD or steroid treatment duration. Notably, those who presented with irreversible vascular damage at onset were preferably treated with TCZ [OR (95% CI) = 1.30 (1.00–1.70)] (p=0.014)]. During follow-up, 36% (15/41) patients experienced relapse, 93% (14/15) were on MTX, and switched to TCZ after the event. Only 1 patient experienced relapse during TCZ therapy. Among relapses observed in patients on MTX therapy, 35% (5/14) were major relapses. We observed a statistically significant higher risk of relapse in patients treated with MTX compared to those treated with TCZ [OR (95% CI) = 16.33 (2.02–183.70)] (p=0.002)]. <h3>Conclusion:</h3> In our GCA cohort of patients, approximately one-third experienced disease relapse during lifetime follow-up. A significant higher percentage of relapses occurred in patients undergoing MTX therapy. TCZ seemed to be more effective in maintaining remission when tapering steroid therapy. These data, combined with the available literature, support the use of TCZ as the first-line steroid sparing drug treatment in patients with GCA. <h3>REFERENCES:</h3> [1] M. Aussedat et al., "Epidemiology of major relapse in giant cell arteritis: A study-level meta-analysis." [Online]. [2] S. Grazzini et al., "Tocilizumab Vs Methotrexate in a Cohort of Patients Affected by Active GCA: A Comparative Clinical and Ultrasonographic Study," Biologics, vol. 17, pp. 151–160, 2023. [3] B. Hellmich et al., "2018 Update of the EULAR recommendations for the management of large vessel vasculitis," Ann Rheum Dis, vol. 79, no. 1, pp. 19–130, Jan. 2020. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>