Wednesday, 16 Jan 2019

You are here

Early Promise for Steroid-free Approach for Giant Cell Arteritis

A very small study presented at ACR18 looking at tocilizumab monotherapy in patients with a new diagnosis of giant cell arteritis has nevertheless given hope to the tantalising idea that some GCA patients might achieve drug-free remission without steroids, although broader data are required.

Dr. Shuntaro Saito and colleagues from Saitama Medical University and Keio University in Japan prospectively examined eight GCA patients prospectively over 24 months, with the patients receiving a steroid-free regimen of tocilizumab monotherapy limited to 12 months followed by 12 months of observational follow-up.

All eight patients maintained a response at 12 months. Encouragingly, in the following 12 months only two of the patients relapsed and both patients were able to restore response with recommencement of tocilizumab. No patients experienced any ischaemic events attributable to giant cell arteritis, although one patient experienced heart failure at 24 weeks leading to drug cessation while still maintaining drug response. Serial imaging of the aorta did not suggest any vascular changes during the follow-up period.

While any such approach would need to be supported by data from more patients, with long-term follow-up of efficacy and safety, these results allude to a promise of paradigm change in GCA, a disease whose current therapy is blighted by steroid-related morbidity. Tempering this promise is caution regarding inhibition of IL-6 and its presumed vascular effects without the mitigating effect of corticosteroids, and long-term follow-up are required to determine whether the risk of the most feared complications of GCA are prevented, unchanged or enhanced.

Another encouraging feature of these data was the drug-free remission achieved by most patients and the restoration of disease control with recommencement of drug in those who flared. This observation suggests that a treatment algorithm involving cessation of tocilizumab at twelve months might be appropriate in some patients. Further insights from the follow-up data from the much larger GiACTA study will help to shape this paradigm.

 

 

Add new comment

More Like This

Assessing the Performance of Aging Physicians

A JAMA Viewpoint article examines the performance of aging surgeons and notes that the effects of aging affects physicians variably and that physician competency should be based on functional age (and abilities) rather than chronologic age. This argues against a mandatory retirement age for surgeons.

RheumNow Podcast – Gout Spot Light (1.11.19)

Dr. Jack Cush discusses the highlights from the past week on RheumNow.com:

RheumNow Podcast – A Grand New Year (1.4.19)

Dr. Jack Cush reviews the news and journals for the beginning of 2019. All from RheumNow.com. Best wishes for a charmed 2019! My advice: 1. Just show up. 2. If you can, then you must do. 3. Live each day as if it twas your 1st day/last day/make or break day. 4. Teach.

Best of 2018: U.S. News 2018-19 Rheumatology Rankings

The Annual U.S. News and World Report Rankings of Hospitals has listed the top contenders in the field of rheumatology. The U.S. News Review rates hospitals nationwide in 16 specialties – including rheumatology. Of the 4,500 hospitals covered by U.S. News that were analyzed, 158 were classified nationally in at least one specialty area.

RheumNow Podcast – Rheumatologist Salaries (12.21.18)

Dr. Jack Cush reviews the news from RheumNow for the week ending 12/21/18.