Treatment of giant cell arteritis with ultra-short glucocorticoids and tocilizumab: role of imaging in a prospective observational study

Autor: Francesco Muratore, Chiara Marvisi, Giulia Cassone, Luigi Boiardi, Pamela Mancuso, Giulia Besutti, Lucia Spaggiari, Massimiliano Casali, Stefania Croci, Annibale Versari, Paolo Giorgi Rossi, Mariagrazia Catanoso, Massimo Costantini, Elena Galli, Carlo Salvarani
Rok vydání: 2023
Předmět:
Zdroj: Rheumatology.
ISSN: 1462-0332
1462-0324
DOI: 10.1093/rheumatology/kead215
Popis: Objectives To assess the impact of tocilizumab (TCZ) monotherapy after ultra-short pulses glucocorticoid (GC) on clinical manifestations and vessel inflammation and damage in large vessel-giant cell arteritis (LV-GCA). Methods In this prospective observational study, we enrolled patients with active LV-GCA. All patients received 500 mg per day methylprednisolone intravenously for three consecutive days and weekly subcutaneous TCZ injections from day 4 until week 52. PET/CT was performed in all patients at baseline and at weeks 24 and 52. The primary endpoints were the reduction of PETVAS at weeks 24 and 52 compared with baseline and the proportion of patients with relapse-free remission at weeks 24 and 52. The secondary end point was the proportion of patients with new aortic dilation at weeks 24 and 52. Results 18 patients were included (72% female, mean age 68.5 years). Compared with the baseline value, a significant reduction of PETVAS was observed at weeks 24 and 52, mean (95% CI) reductions -8.6 (-11.5 to -5.7) and -10.4 (-13.6 to -7.2), p= 0.001 and 0.002, respectively. The proportion of patients with relapse-free remission at weeks 24 and 52 was 10/18 (56%, 95% CI 31–78) and 8/17 (47%, 95% CI 23–72), respectively. At weeks 24 and 52 no patient showed new aortic dilation. However, 4 dilated patients at baseline showed a significant increase in aortic diameter (≥5 mm) at week 52. Conclusions TCZ monotherapy after ultra-short GCs controlled the clinical symptoms of GCA and reduced vascular inflammation. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov, NCT05394909.
Databáze: OpenAIRE
Externí odkaz: