Pulse Steroids with Tocilizumab in Giant Cell Arteritis Save

A pilot study assessed pulse methoprednisolone with weekly subcutaneous tocilizumab (TCZ) in patients with large vessel-GCA (LV-GCA) and showed that a sizeable minority will relapse after the TCZ is discontinued. 

The TOPAZIO study was an open-lable trial of 17 patients with LV-GCA treated with 3 boluses of intravenous methylprednisone and weekly subcutaneous TCZ in monotherapy for 52 weeks with After 52 weeks, 13/17 were in clinical remission and TCZ was discontinued and patients entered a 26-week observational follow-up period. PET/CT assessments of vascular activity was assessed throughout.  The primary outcome was vascular activity as measure by PET (PETVAS) at week 78 and the proportion of patients with relapse-free clinical remission at week 78. 

At week 78 PETVAS was significantly reduced (mean change -6.6 (-9.5 to -3.7). But after week week 52, PETVAS significantly increased  with TCZ discontinuation (week 78), mean change 4.6 (0.7–8.5). 

The proportion of patients with relapse-free clinical remission: 

• Weeks 78 = 11/17
• End of the follow-up (median time from TCZ discontinuation 148 weeks) = 8/17 
• Six patients were active by PETVAS, despite being considered in clinical remission.

While a majority of LV-GCA patients maintained drug-free clinical remission after discontinuation of TCZ, many patients will flare and relapses may be predicted by PETVAS (vascular activity scores).