Risk of relapse after discontinuation of tocilizumab therapy in giant cell arteritis.

Adler, Sabine; Reichenbach, Stephan; Gloor, Andrea; Yerly, Daniel; Cullmann, Jennifer; Villiger, Peter M. (2019). Risk of relapse after discontinuation of tocilizumab therapy in giant cell arteritis. Rheumatology, 58(9), pp. 1639-1643. Oxford University Press 10.1093/rheumatology/kez091

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OBJECTIVE It is currently unknown how long GCA should be treated with tocilizumab. In the first randomized controlled trial, the biologic agent was stopped after 52 weeks. We therefore studied what proportion of patients relapsed, when relapses occurred and whether factors might predict relapse after tocilizumab treatment discontinuation. METHODS All patients in the tocilizumab arm who had received a 52-week treatment were evaluated. In case of lasting remission, magnetic resonance angiography (MRA) was performed and sera were taken to search for biomarkers associated with subclinical disease activity. RESULTS Seventeen of 20 patients randomized to the tocilizumab treatment arm were in lasting remission without any co-medication at week 52. Mean follow-up after study end was 28.1 months (range 17-44). Eight patients relapsed after a mean of 6.3 months (range 2-14) (six within the first 5 months, two patients at months 13 and 14, respectively). Relapsing patients were younger and showed more signs of mural enhancement in MRA compared with non-relapsing patients. MRA documented low-intensity vessel wall signals in all subjects. No morphological changes such as formation of aneurysm of aorta occurred. Biomarkers in sera did not indicate subclinical disease activity: levels of IL-6, MMP-3, soluble TNF receptor 2, soluble CD163, soluble intercellular adhesion molecule-1 and Pentraxin-3 did not differ from matched healthy controls. CONCLUSION The data show that a 52-week treatment with tocilizumab induces a lasting remission that persists in half of the patients after treatment stop. None of the clinical, serological or MRA findings qualify to predict relapse. Remarkably, MRA revealed a persisting wall enhancement of the descending aorta.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Rheumatology, Clinical Immunology and Allergology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Reichenbach, Stephan; Gloor, Andrea Daniela; Cullmann, Jennifer and Villiger, Peter

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1462-0324

Publisher:

Oxford University Press

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

31 May 2019 14:38

Last Modified:

08 Nov 2019 10:18

Publisher DOI:

10.1093/rheumatology/kez091

PubMed ID:

30915462

Uncontrolled Keywords:

biomarker giant cell arteritis imaging relapse tocilizumab

BORIS DOI:

10.7892/boris.129420

URI:

https://boris.unibe.ch/id/eprint/129420

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