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Background: Tocilizumab (TCZ) is the only biologic drug approved for the treatment of giant cell arteritis (GCA), having clinical trials and real-life studies proved its efficacy and safety. However, optimal duration of the treatment has yet to be determined, being its early interruption associated with an increased risk of relapse. Conversely, prolonged schemes of therapy may rise safety concerns. Objectives: The aim of the study was to evaluate the incidence of adverse events (AEs) and remission/relapse rate in a cohort of GCA patients treated with TCZ and an accelerated steroid tapering scheme, followed for 24 months. Methods: We retrospectively included patients referring to our clinic from January 2019 to November 2021 who were diagnosed with GCA and started subcutaneous TCZ treatment (162 mg/week). They also received up to 62,5 mg prednisone (PDN), tapered following an accelerated six-month scheme (Table 1). All patients underwent influenza and pneumococcal and, upon available in Italy, recombinant zoster vaccination. Results: We collected 38 patients, with a mean age of 76,4 years, treated for an average of 22,3 months. AEs occurred in 12 (32%) subjects, and only one episode of serious event was reported; 7 (18%) patients permanently discontinued TCZ. At the end of follow-up, all the patients continuing treatment showed clinical remission, and only 15% continued to require the administration of GCs (Conclusion: Our data, coming from one of the few studies covering an extended period of treatment of almost 2 years with TCZ in GCA, support the evidence of a safe and effective long-term use of anti-IL6R agents, especially when combined with low cumulative GCs doses. The occurrence of AEs after >1 year of treatment, instead of within the first six months of treatment as previously reported, possibly suggests a smaller effect of TCZ in their determination, compared to other contributing factors. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.
Conticini et al. (Sat,) studied this question.