title: Tocilizumab in giant cell arteritis: Multicenter open-label study of 22 patients.
abstract: OBJECTIVE
  To assess the efficacy of tocilizumab (TCZ) in giant cell arteritis (GCA) patients with refractory disease and/or with unacceptable side effects due to corticosteroids.
  
  
  METHODS
  A retrospective multicenter open-label study on 22 GCA patients treated with TCZ at standard dose of 8mg/kg/month. The main outcomes were achievement of disease remission and reduction of corticosteroid dose.
  
  
  RESULTS
  The mean age ± standard deviation of patients was 69 ± 8 years. The main clinical features at TCZ onset were polymyalgia rheumatica (n = 16), asthenia (n = 7), headache (n =5), constitutional symptoms (n = 4), jaw claudication (n = 2), and visual loss (n = 2). Besides corticosteroids and before TCZ onset, 19 of 22 patients had also received several conventional immunosuppressive and/or biologic drugs. Of 22 patients, 19 achieved rapid and maintained clinical improvement following TCZ therapy. Also, after a median follow-up of 9 (interquartile range: 6-19) months, the C-reactive protein level had fallen from 1.9 (1.2-5.4) to 0.2 (0.1-0.9)mg/dL (p < 0.0001) and the erythrocyte sedimentation rate decreased from 44 (20-81) to 12 (2-20)mm/1st hour (p = 0.001). The median dose of prednisone was also tapered from 18.75 (10-45) to 5 (2.5-10)mg/day (p < 0.0001). However, TCZ had to be discontinued in 3 patients due to severe neutropenia, recurrent pneumonia, and cytomegalovirus infection. Moreover, 1 patient died after the second infusion of TCZ due to a stroke in the setting of an infectious endocarditis.
  
  
  CONCLUSIONS
  TCZ therapy leads to rapid and maintained improvement in patients with refractory GCA and/or with unacceptable side effects related to corticosteroids. However, the risk of infection should be kept in mind when using this drug in patients with GCA.
authors.affiliation: Department of Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda. Valdecilla s/n., Santander, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Loricera
authors.affiliation: Department of Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda. Valdecilla s/n., Santander, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Blanco
authors.affiliation: Department of Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda. Valdecilla s/n., Santander, Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: Hernández
authors.affiliation: Department of Rheumatology, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain.
authors.forename: Santos
authors.initials: S
authors.lastname: Castañeda
authors.affiliation: Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Mera
authors.affiliation: Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Pérez-Pampín
authors.affiliation: Department of Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda. Valdecilla s/n., Santander, Spain.
authors.forename: Enriqueta
authors.initials: E
authors.lastname: Peiró
authors.affiliation: Department of Rheumatology, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Humbría
authors.affiliation: Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Calvo-Alén
authors.affiliation: Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Aurrecoechea
authors.affiliation: Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Narváez
authors.affiliation: Department of Rheumatology, Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: Amalia
authors.initials: A
authors.lastname: Sánchez-Andrade
authors.affiliation: Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Vela
authors.affiliation: Department of Rheumatology, Complejo Asistencial Universitario de León, León, España.
authors.forename: Elvira
authors.initials: E
authors.lastname: Díez
authors.affiliation: Department of Rheumatology, Hospital de Laredo, Laredo, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mata
authors.affiliation: Department of Rheumatology, Hospital Mateu Orfila, Menorca, Spain.
authors.forename: Pau
authors.initials: P
authors.lastname: Lluch
authors.affiliation: Department of Rheumatology, Hospital Mateu Orfila, Menorca, Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: Moll
authors.affiliation: Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.
authors.forename: Íñigo
authors.initials: Í
authors.lastname: Hernández
authors.affiliation: Department of Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda. Valdecilla s/n., Santander, Spain.
authors.forename: Vanesa
authors.initials: V
authors.lastname: Calvo-Río
authors.affiliation: Department of Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda. Valdecilla s/n., Santander, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ortiz-Sanjuán
authors.affiliation: Department of Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda. Valdecilla s/n., Santander, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: González-Vela
authors.affiliation: Department of Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda. Valdecilla s/n., Santander, Spain.
authors.forename: Trinitario
authors.initials: T
authors.lastname: Pina
authors.affiliation: Department of Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avda. Valdecilla s/n., Santander, Spain. Electronic address: miguelaggay@hotmail.com.
authors.forename: Miguel Á
authors.initials: MÁ
authors.lastname: González-Gay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000276:immunology; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011111:Polymyalgia Rheumatica / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D002097:C-Reactive Protein; C502936:tocilizumab
keywords: Biological therapy; Giant cell arteritis; Large-vessel vasculitis; Tocilizumab