Tocilizumab in refractory giant cell arteritis. Monotherapy versus combined therapy with conventional immunosuppressive drugs. Observational multicenter study of 134 patients
Por:
Calderon-Goercke, M, Castaneda, S, Aldasoro, V, Villa, I, Moriano, C, Romero-Yuste, S, Narvaez, J, Gomez-Arango, C, Perez-Pampin, E, Melero, R, Becerra-Fernandez, E, Revenga, M, Alvarez-Rivas, N, Galisteo, C, Sivera, F, De Miguel, E, Prieto-Pena, D, Gonzalez-Gay, M, Hernandez, J, Blanco, R and Tocilizumab Giant Cell Arteritis S
Publicada:
1 abr 2021
Ahead of Print:
1 feb 2021
Categoría:
Anesthesiology and pain medicine
Resumen:
Objective: To compare the efficacy and safety of TCZ in monotherapy (TCZ(MONO)) vs. combined with conventional immunosuppressive drugs (TCZ(COMBO)) in Giant Cell Arteritis (GCA) in a clinical practice scenario. Methods: Multicenter study of 134 patients with refractory GCA. Patients on TCZ(MONO) (n = 82) were compared with those on TCZ(COMBO) (n = 52). Drugs were methotrexate (MTX) (n = 48), azathioprine (n = 3), and lefluno-mide (n = 1). The main outcomes were: prolonged remission (normalization of clinical and laboratory parameters for at least 6 months) and the number of relapses.
Results: Patients on TCZ(COMBO) were younger (68.8 +/- 8.0 vs 71.2 +/- 9.0 years; p = 0.04), with a trend to a longer GCA duration (median [IQR],18.5 [6.25-34.0] vs. 13.0 [7.75-33.5] months; p = 0.333), higher C-reactive protein (CRP) levels (2.1[1-4.7] vs 1.2 [0.2-2.4] mg/dL; p = 0.003), and more prevalence of extra-cranial large vessel vasculitis (LVV) (57% vs. 34.1%; p = 0.007). In both groups, rapid and sustained improvement was observed. Despite the longer GCA duration, and the higher CRP levels and prevalence of LVV in the TCZ(COMBO), the improvement was similar in both groups at 12 months. Moreover, in the TCZ(COMBO) group, prolonged remission was significantly higher at 12-month. Relapses and serious adverse events were similar in both groups.
Conclusion: In clinical practice, TCZ in monotherapy or combined with conventional immunosuppressive agents is effective and safe in patients with GCA. Nevertheless, the addition of immunosuppressive drugs, usually MTX, seems to allow a higher rate of prolonged remission, even in patients with a longer GCA duration, more extra-cranial LVV involvement, and higher acute-phase reactants. (C) 2021 Elsevier Inc. All rights reserved.
Filiaciones:
Calderon-Goercke, M:
Santander Univ Cantabria, Hosp Univ Marques Valdecilla, Dept Rheumatol, IDIVAL, Avda Valdecilla S-N, ES-39008 Santander, Spain
Santander Univ Cantabria, Hosp Univ Marques Valdecilla, Dept Internal Med, IDIVAL, Avda Valdecilla S-N, ES-39008 Santander, Spain
Castaneda, S:
Univ Autonoma UAM, Hosp Univ La Princesa, Dept Rheumatol, EPID Future,IIS Princesa,Catedra UAM Roche, Madrid, Spain
Aldasoro, V:
Complejo Hosp Navarra, Dept Rheumatol, Navarra, Spain
Villa, I:
Hosp Sierrallana, Dept Rheumatol, Torrelavega, Cantabria, Spain
Moriano, C:
Complejo Asistencial Univ Leon, Dept Rheumatol, Leon, Spain
Romero-Yuste, S:
Complejo Hosp Univ Pontevedra, Dept Rheumatol, Pontevedra, Spain
Narvaez, J:
Hosp Bellvitge Princeps Espanya, Dept Rheumatol, Barcelona, Spain
Gomez-Arango, C:
Hosp Alto Deba, Dept Rheumatol, Arrasate Mondragon, Spain
Perez-Pampin, E:
Complejo Hosp Univ Santiago, Dept Rheumatol, Santiago De Compostela, Spain
Melero, R:
Complexo Hosp Univ Vigo, Dept Rheumatol, Vigo, Spain
:
Hosp Univ Torrevieja, Dept Rheumatol, Alicante, Spain
Revenga, M:
Hosp Ramon & Cajal, Dept Rheumatol, Madrid, Spain
Alvarez-Rivas, N:
Hosp Univ Lucus Augusti, Dept Rheumatol, Lugo, Spain
Galisteo, C:
Hosp Parc Tauli, Dept Rheumatol, Barcelona, Spain
:
Hosp Univ Elda, Dept Rheumatol, Alicante, Spain
De Miguel, E:
Hosp La Paz, Dept Rheumatol, Madrid, Spain
Prieto-Pena, D:
Santander Univ Cantabria, Hosp Univ Marques Valdecilla, Dept Rheumatol, IDIVAL, Avda Valdecilla S-N, ES-39008 Santander, Spain
Santander Univ Cantabria, Hosp Univ Marques Valdecilla, Dept Internal Med, IDIVAL, Avda Valdecilla S-N, ES-39008 Santander, Spain
Gonzalez-Gay, M:
Santander Univ Cantabria, Hosp Univ Marques Valdecilla, Dept Rheumatol, IDIVAL, Avda Valdecilla S-N, ES-39008 Santander, Spain
Santander Univ Cantabria, Hosp Univ Marques Valdecilla, Dept Internal Med, IDIVAL, Avda Valdecilla S-N, ES-39008 Santander, Spain
Hernandez, J:
Santander Univ Cantabria, Hosp Univ Marques Valdecilla, Dept Rheumatol, IDIVAL, Avda Valdecilla S-N, ES-39008 Santander, Spain
Santander Univ Cantabria, Hosp Univ Marques Valdecilla, Dept Internal Med, IDIVAL, Avda Valdecilla S-N, ES-39008 Santander, Spain
Blanco, R:
Santander Univ Cantabria, Hosp Univ Marques Valdecilla, Dept Rheumatol, IDIVAL, Avda Valdecilla S-N, ES-39008 Santander, Spain
Santander Univ Cantabria, Hosp Univ Marques Valdecilla, Dept Internal Med, IDIVAL, Avda Valdecilla S-N, ES-39008 Santander, Spain
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