TY - JOUR
T1 - Relapse after cessation of weekly tocilizumab for giant cell arteritis
T2 - a multicentre service evaluation in England
AU - TOC STOP 2022 Investigators
AU - Quick, Vanessa
AU - Abusalameh, Mahdi
AU - Ahmed, Sajeel
AU - Alkoky, Hoda
AU - Bukhari, Marwan
AU - Carter, Stuart
AU - Coath, Fiona L
AU - Davidson, Brian
AU - Doddamani, Parveen
AU - Dubey, Shirish
AU - Ducker, Georgina
AU - Griffiths, Bridget
AU - Gullick, Nicola
AU - Heaney, Jonathan
AU - Holloway, Amelia
AU - Htut, Ei Ei Phyu
AU - Hughes, Mark
AU - Irvine, Hannah
AU - Kinder, Alison
AU - Kurshid, Asim
AU - Lim, Joyce
AU - Ludwig, Dalia R
AU - Malik, Mariam
AU - Mercer, Louise
AU - Mulhearn, Ben
AU - Nair, Jagdish R
AU - Patel, Rikesh
AU - Robson, Joanna
AU - Saha, Pratyasha
AU - Tansley, Sarah
AU - Mackie, Sarah L
PY - 2024/12/31
Y1 - 2024/12/31
N2 - OBJECTIVES: The National Health Service in England funds 12 months of weekly subcutaneous tocilizumab (qwTCZ) for patients with relapsing or refractory giant cell arteritis (GCA). During the COVID-19 pandemic, some patients were allowed longer treatment. We sought to describe what happened to patients after cessation of qwTCZ.METHODS: Multicentre service evaluation of relapse after stopping qwTCZ for GCA. The log-rank test was used to identify significant differences in time to relapse.RESULTS: 336 GCA patients were analysed from 40 centres, treated with qwTCZ for a median (interquartile range, IQR) of 12 (12-17) months. At time of stopping qwTCZ, median (IQR) prednisolone dose was 2 (0-5) mg/day. By 6, 12 and 24 months after stopping qwTCZ, 21.4%, 35.4% and 48.6% respectively had relapsed, requiring an increase in prednisolone dose to a median (IQR) of 20 (10-40) mg/day. 33.6% of relapsers had a major relapse as defined by EULAR. Time to relapse was shorter in those that had previously also relapsed during qwTCZ treatment (P = 0.0017); in those not in remission at qwTCZ cessation (P = 0.0036); and in those with large vessel involvement on imaging (P = 0.0296). Age ≥65, gender, GCA-related sight loss, qwTCZ treatment duration, TCZ taper, prednisolone dosing, and conventional synthetic DMARD use were not associated with time to relapse.CONCLUSION: Up to half our patients with GCA relapsed after stopping qwTCZ, often requiring a substantial increase in prednisolone dose. One third of relapsers had a major relapse. Extended use of TCZ or repeat treatment for relapse should be considered for these patients.
AB - OBJECTIVES: The National Health Service in England funds 12 months of weekly subcutaneous tocilizumab (qwTCZ) for patients with relapsing or refractory giant cell arteritis (GCA). During the COVID-19 pandemic, some patients were allowed longer treatment. We sought to describe what happened to patients after cessation of qwTCZ.METHODS: Multicentre service evaluation of relapse after stopping qwTCZ for GCA. The log-rank test was used to identify significant differences in time to relapse.RESULTS: 336 GCA patients were analysed from 40 centres, treated with qwTCZ for a median (interquartile range, IQR) of 12 (12-17) months. At time of stopping qwTCZ, median (IQR) prednisolone dose was 2 (0-5) mg/day. By 6, 12 and 24 months after stopping qwTCZ, 21.4%, 35.4% and 48.6% respectively had relapsed, requiring an increase in prednisolone dose to a median (IQR) of 20 (10-40) mg/day. 33.6% of relapsers had a major relapse as defined by EULAR. Time to relapse was shorter in those that had previously also relapsed during qwTCZ treatment (P = 0.0017); in those not in remission at qwTCZ cessation (P = 0.0036); and in those with large vessel involvement on imaging (P = 0.0296). Age ≥65, gender, GCA-related sight loss, qwTCZ treatment duration, TCZ taper, prednisolone dosing, and conventional synthetic DMARD use were not associated with time to relapse.CONCLUSION: Up to half our patients with GCA relapsed after stopping qwTCZ, often requiring a substantial increase in prednisolone dose. One third of relapsers had a major relapse. Extended use of TCZ or repeat treatment for relapse should be considered for these patients.
U2 - 10.1093/rheumatology/kead604
DO - 10.1093/rheumatology/kead604
M3 - Article
C2 - 37952183
SN - 1462-0324
VL - 63
SP - 3407
EP - 3414
JO - Rheumatology (Oxford, England)
JF - Rheumatology (Oxford, England)
IS - 12
ER -