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Relapse after cessation of weekly tocilizumab for giant cell arteritis: a multicentre service evaluation in England.

Authors :
Quick, Vanessa
Abusalameh, Mahdi
Ahmed, Sajeel
Alkoky, Hoda
Bukhari, Marwan
Carter, Stuart
Coath, Fiona L
Davidson, Brian
Doddamani, Parveen
Dubey, Shirish
Ducker, Georgina
Griffiths, Bridget
Gullick, Nicola
Heaney, Jonathan
Holloway, Amelia
Htut, Ei Ei Phyu
Hughes, Mark
Irvine, Hannah
Kinder, Alison
Kurshid, Asim
Source :
Rheumatology. Dec2024, Vol. 63 Issue 12, p3407-3414. 8p.
Publication Year :
2024

Abstract

Objectives The National Health Service in England funds 12 months of weekly s.c. tocilizumab (qwTCZ) for patients with relapsing or refractory GCA. During the coronavirus disease 2019 (COVID-19) pandemic, some patients were allowed longer treatment. We sought to describe what happened to patients after cessation of qwTCZ. Methods Multicentre service evaluation of relapse after stopping qwTCZ for GCA. The log-rank test was used to identify significant differences in time to relapse. Results A total of 336 GCA patients were analysed from 40 centres, treated with qwTCZ for a median [interquartile range (IQR)] of 12 (12–17) months. At time of stopping qwTCZ, median (IQR) prednisolone dose was 2 (0–5) mg/day. By 6, 12 and 24 months after stopping qwTCZ, 21.4%, 35.4% and 48.6%, respectively, had relapsed, requiring an increase in prednisolone dose to a median (IQR) of 20 (10–40) mg/day. 33.6% relapsers had a major relapse as defined by EULAR. Time to relapse was shorter in those that had previously also relapsed during qwTCZ treatment (P  = 0.0017), in those not in remission at qwTCZ cessation (P  = 0.0036) and in those with large vessel involvement on imaging (P  = 0.0296). Age ≥65 years, gender, GCA-related sight loss, qwTCZ treatment duration, TCZ taper, prednisolone dosing and conventional synthetic DMARD use were not associated with time to relapse. Conclusion Up to half our patients with GCA relapsed after stopping qwTCZ, often requiring a substantial increase in prednisolone dose. One-third of relapsers had a major relapse. Extended use of TCZ or repeat treatment for relapse should be considered for these patients. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
14620324
Volume :
63
Issue :
12
Database :
Academic Search Index
Journal :
Rheumatology
Publication Type :
Academic Journal
Accession number :
181249392
Full Text :
https://doi.org/10.1093/rheumatology/kead604