In England, there is a "hard stop" to weekly tocilizumab (qwTCZ) therapy for GCA; this is currently 12 months but was extended during the COVID-19 pandemic subject to certain criteria for GCA relapse risk. Taking advantage of variation in practice, we aimed to compare outcomes of GCA patients who tapered TCZ vs those who stopped abruptly (non-taper patients). Secondary analysis of an English multicentre service evaluation of relapse after stopping qwTCZ for GCA. Time to relapse was compared between taper and non-taper patients. We examined outcomes according to whether they had been "adequate responders" during qwTCZ therapy, defined as those in remission and on ≤ 5mg prednisolone at qwTCZ cessation, without relapse whilst taking qwTCZ. We analysed 336 patients from 40 centres. Time to relapse after qwTCZ cessation was significantly longer in adequate responders than non-adequate responders (p = 0.0004).17.0% (57/336) patients tapered to fortnightly TCZ after qwTCZ cessation, for a median of 6 (IQR 2-13) months. For adequate responders, time to relapse whilst taking tapered-dose TCZ was significantly longer compared with those in the non-taper group (p = 0.0231) based on a relatively small number of flares. There was no difference between the taper and non-tapered groups after tapered TCZ was stopped (p = 0.8346). In contrast, time to relapse for non-adequate responders was similar in taper-patients compared with non-taper patients (p= 0.4892). Tapering TCZ after qwTCZ cessation delayed relapse only during the tapering period, but only in adequate responders to qwTCZ. No lasting benefit was seen after tapering ended.
Quick et al. (Sun,) studied this question.
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