Tuesday, 18 Jun 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

EULAR 2019- Day 4 Report

Saturday June 15th was the last half-day at EULAR 2019 but was highlighted by the “late-breaking” (LB) presentations that were presented from the podium and by poster.

Below are the top “LB” presentations from EULAR this year:

Understanding Non-arthritic Rheumatic iRAEs

A better understanding of rheumatic immune-related adverse event phenotypes beyond inflammatory arthritis has been furthered by work from three abstracts presented at EULAR 2019 in Madrid.

Ultrasound Reveals Which Anti-CCP Positive Patients Progress to Arthritis 

Power Doppler signal on baseline ultrasound exam may well help stratify anti-CCP positive patients with musculoskeletal symptoms but no clinical synovitis, according to data from the Leeds Institute of Rheumatic and Musculoskeletal Medicine presented at EULAR 2019.

EULAR 2019 – Day 3 Report

The third day of EULAR 2019 started with novel biologics, the efficacy of secukinumab in axial psoriatic arthritis, neurologic events with TNF inhibitors from the DANBIO database (OP0261), and neuropathy in SLE (OP0252), but above all this was a big poster day. Here are selected highlights from day 3 EULAR in Madrid.

RheumNow Podcast – EULAR 2019 Streamin' - (6.14.19)

Dr. Jack Cush reports from Madrid on several novel presentations from EULAR 2019.

1. Genovese Vagal nerve stimulator in RA

2. Low dose steroids in Hand OA