Tocilizumab Efficacy in Giant Cell Arteritis Phenotypes Save

A Spanish Collaborative Group study of Tocilizumab (TCZ) in Giant Cell Arteritis (GCA) demonstrated high efficacy regardless of the different vascular phenotypes treated. 

Multicentre study of 471 GCA patients treated with TCZ, assessed outcomes according to vascular phenotypes: a) cranial (cGCA), b) extracranial (ecGCA) and c) mixed (mixGCA).  Outcomes included clinical remission, EULAR complete remission, relapses, absence of inflammation in imaging techniques, and safety.

Patients were elderly (mean age 74  years) and mostly female (n=342).  The Vascular phenotypes were:

• cGCA (46%)
• mixGCA (37%) 
• ecGCA (17%). 

ecGCA patients were younger (66 yrs vs 75 & 71yrs), and had a longer delayed GCA diagnosis (median 6 months). While systemic manifestations were similar, ischemic manifestations were more frequent in cGCA. 

Clinical remission in the first month was observed more in cGCA/51%, than ecGCA/43% or mixGCA/47%. By 24 months remission rates were nearly the same (79%/81%/89%). Similar outcomes were seen looking at complete EULAR remission after one month (35%/27%/28%) and 24 months (72%/73%/67%).

Inflammation on imaging was more common with cGCA, and much less commonly seen with ecGCA/mixGCA at 12 months (15%/26%) and 24 months (22%/7%).

TCZ shows a rapid and sustained effectiveness in all GCA vascular phenotypes.