Tocilizumab in refractory giant cell arteritis. Monotherapy versus combined therapy with conventional immunosuppressive drugs. Observational multicenter study of 134 patients
| Autor: | Noelia Alvarez-Rivas, Francisca Sivera, Susana Romero-Yuste, Carles Galisteo, Santos Castañeda, Monica Calderón-Goercke, Elena Becerra-Fernández, Ignacio Villa, José L. Hernández, Vicente Aldasoro, Diana Prieto-Peña, Eugenio de Miguel, Rafael Melero, Miguel A. González-Gay, Ricardo Blanco, Eva Perez-Pampin, Catalina Gomez-Arango, Javier Narváez, Marcelino Revenga, Clara Moriano |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Giant Cell Arteritis Azathioprine Antibodies Monoclonal Humanized Gastroenterology 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Tocilizumab Rheumatology Refractory Internal medicine medicine Humans 030212 general & internal medicine Adverse effect Leflunomide 030203 arthritis & rheumatology business.industry medicine.disease Giant cell arteritis Anesthesiology and Pain Medicine Treatment Outcome chemistry Pharmaceutical Preparations Methotrexate Vasculitis business Immunosuppressive Agents medicine.drug |
| Zdroj: | Seminars in arthritis and rheumatism. 51(2) |
| ISSN: | 1532-866X |
| Popis: | Objective To compare the efficacy and safety of TCZ in monotherapy (TCZMONO) vs. combined with conventional immunosuppressive drugs (TCZCOMBO) in Giant Cell Arteritis (GCA) in a clinical practice scenario. Methods Multicenter study of 134 patients with refractory GCA. Patients on TCZMONO (n = 82) were compared with those on TCZCOMBO (n = 52). Drugs were methotrexate (MTX) (n = 48), azathioprine (n = 3), and leflunomide (n = 1). The main outcomes were: prolonged remission (normalization of clinical and laboratory parameters for at least 6 months) and the number of relapses. Results Patients on TCZCOMBO were younger (68.8 ± 8.0 vs 71.2 ± 9.0 years; p = 0.04), with a trend to a longer GCA duration (median [IQR],18.5 [6.25–34.0] vs. 13.0 [7.75–33.5] months; p = 0.333), higher C-reactive protein (CRP) levels (2.1[1–4.7] vs 1.2 [0.2–2.4] mg/dL; p = 0.003), and more prevalence of extra-cranial large-vessel vasculitis (LVV) (57% vs. 34.1%; p = 0.007). In both groups, rapid and sustained improvement was observed. Despite the longer GCA duration, and the higher CRP levels and prevalence of LVV in the TCZCOMBO, the improvement was similar in both groups at 12 months. Moreover, in the TCZCOMBO group, prolonged remission was significantly higher at 12-month. Relapses and serious adverse events were similar in both groups. Conclusion In clinical practice, TCZ in monotherapy or combined with conventional immunosuppressive agents is effective and safe in patients with GCA. Nevertheless, the addition of immunosuppressive drugs, usually MTX, seems to allow a higher rate of prolonged remission, even in patients with a longer GCA duration, more extra-cranial LVV involvement, and higher acute-phase reactants. |
| Databáze: | OpenAIRE |
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