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Novel treatment options for Giant Cell Arteritis

Richard Conway, MBBChBAO, PhD Nov 06, 2021

Giant cell arteritis is associated with significant treatment related morbidity due to the dependence on glucocorticoids as a treatment option. After sixty years of therapeutic stagnation, these are exciting times in the management of GCA. At this year's ACR Convergence meeting, encouraging data will be presented on options for GCA.

Novel treatment options for Giant Cell Arteritis At this #ACR21, encouraging data will be presented on two such potential options for GCA. https://t.co/gyVXHDRXrj @RichardPAConway https://t.co/V2Fg8kCjWy

https://bit.ly/3qbljCz

Results from @rheum_covid on #COVID19 outcomes in patients with #vasculitis #Abs0952 #ACR21 👉🏼~1000 pts 👉🏼Severe outcomes esp in #GCA and #AAV 👉🏼Older age, comorbidities, disease activity, high-dose steroids assoc with worse outcomes @RheumNow https://t.co/e2UlgDpyjw https://t.co/skoTKVYbEL

Outcomes of COVID-19 Infection in Patients with Primary Systemic Vasculitis and…

@zach_wallace_md on RTX vs CYC remission induction in AAV. Multivariable and propensity score matching. No difference in ESRD or mortality. Real world confirmation of RAVE. Abstr#954 #ACR21 @RheumNow https://t.co/oSauqV8JnD

Does AAV induction choice (CYC v RTX) affect long-term outcomes (that might be missed in clinical trials)? Boston data done two ways: multivar analysis & trial emulation using PS CYC and RTX-based induction both perform equally well over many years👍 #ACR21 ABST0954 @RheumNow https://t.co/8BZRgKiQNB

Dr Strand presents HRQoL measures for avacopan from ADVOCATE trial. Better HRQoL outcomes with avacopan. Great to have PRO data. Abstr#0955 #ACR21 @RheumNow https://t.co/9qBAHETX7s

@SattuiSEMD presents @rheum_covid data on COVID-19 outcomes in vasculitis/PMR. High rates of severe outcomes, particularly for AAV and GCA (mortality >20% for both). Multiple factors associated with outcomes (see below). Abstr#952 #ACR21 @RheumNow #ACRBest https://t.co/0lw1QhuJct

So important for our systemic vasculitis & PMR pts, @rheum_covid data highlighting the outsized COVID-19 risks they face. Thanks @SattuiSEMD @RichardPAConway @EBRheum in particular for driving forward this badly needed work! #ACR21 ABST0952 @RheumNow https://t.co/L7XS9OblxI https://t.co/LYxR1WUlhM

David Liew on Twitter: "Looking forward to hearing it presented by @Sattui…

#ACR21 #Abstr0437 OK, so RTX affects #COVID vaccine but some pts need RTX. Factors predicting response to vaccine: RA vs AAV/IIM Higher IgG Longer time-to-RTX Lower RTX courses Number. Prediction Calculator is developed but need ext. validation #RheumNow https://t.co/iXSaGQ76hS https://t.co/WQAV3GRPBz

You searched for - ACR Meeting Abstracts

Dr. Marvisi presented a case: refractory MPA relapsed w/prednisone < 25 mg/day. Genetic studies c/w VEXAS. Is MPA/vasculitis part of VEXAS? The experts say: Maybe- VEXAS is such a new entity, there may be a common pathway (e.g NFkB affected by ubiquination, IL-6 role) #ACR21 https://t.co/kEOsruJ8DE

In GCA, why might you target GM-CSF over IL-6? Entirely plausible TCZ might be leaving some Th1 stones unturned, esp: vascular remodelling downreg pathways Transcriptomics from toci/mavri-treated TAB show it's plausible beyond just theory... Cid group #ACR21 ABST0506 @RheumNow https://t.co/YephlzHOdj

Do you use ANCA to change Rx in prevalent GPA pts? GS401 #ACR21 @RheumNow

Dr De Miguel on subclinical large vessel vasculitis in PMR. US assessment. 22% had subclinical GCA. 90% LVV, 10% cranial GCA. Abstr#0466 #ACR21 @RheumNow https://t.co/PDCynMAigi

Our latest article on outcomes of patients with vasculitis and PMR and COVID-19 published in @TheLancetRheum . @rheum_covid project with co-leads @SattuiSEMD and @EBRheum . https://t.co/8NTAafdYRA

https://www.sciencedirect.com/science/article/pii/S2665991321003167

📌Pre-Test Probability in GCA ESR/CRP can be normal: ~10% of pts at diagnosis -20-40% at time or relapse #ACR21 #ACRAmbassador #RheumTwitter https://t.co/kenaD31pYa

Dr Doliner @zach_wallace_md on ILD in AAV. ILD in 13% - of which 76% fibrotic. UIP most common. Most MPO+, but also rarely seen with PR3+. 47% ⬆️ risk of death. Abstr#0430 #ACR21 @RheumNow https://t.co/6MnxqW92bz

Dr O'Brien on co-existent AAV and RA. Not something I'm used to seeing, but maybe we need to think about it more? 25 cases with RA+AAV, 52 with RA + ANCA but no AAV, not sure what the denominator is here though. Abstr#0428 #ACR21 @RheumNow @profgayecunnane https://t.co/fN3BRpc7UJ

How much ritux for AAV maintenance? Ever since we started using it, no-one's been sure. If absolute B cell depletion is your goal, @VUMCRheum data suggest >3.3mg/d is safest for that 500mg q6m = 2.7 mg/d 500mg q4m = 4.1 mg/d 1000mg q6m = 5.5mg/d #ACR21 ABST0416 @RheumNow https://t.co/mYAgKhHT7j

Dr Springer on pharmacological response of RTX in ANCA-vasculitis. Suggest that 500mg every 6 months may not achieve sufficient B cell depletion in all. What are the clinical implications? Is anyone dosing 500mg as standard? Abstr#0416 #ACR21 @RheumNow https://t.co/w36hSYbW1B

In ANCA-associated vasculitis, does reverse seroconverting (ANCA+➡️ANCA-) make a difference? relapse - no ESRD - no death - no Don't measure serial ANCAs for prognosis (no diff MPO/PR3, RTX/CYC) target trial emulation @BrighamWomens @MGHrheumatology #ACR21 ABST0419 @RheumNow https://t.co/rLkTY0ul8f

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Novel treatment options for Giant Cell Arteritis

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