2414: Relapse in Giant Cell Arteritis Treated with Tocilizumab. Predictive Factors

Fernando López¹, Javier Loricera², Ivan Ferraz Amaro³, Santos Castañeda⁴, Clara Moriano Morales⁵, Javier Narvaez⁶, Vicente Aldasoro⁷, Olga Maiz⁸, Rafael Benito Melero-Gonzalez⁹, Juan I. Villa¹⁰, PALOMA VELA¹¹, Susana Romero Yuste¹², Jose L. Callejas¹³, Eugenio De Miguel¹⁴, Eva Galindez-Agirregoikoa¹⁵, Francisca Sivera¹⁶, Jesús Carlos Fernández López¹⁷, Arturo Llobell¹⁸, Julio Sánchez-Martín¹⁹, Calderon Goercke², Lara Sanchez-Bilbao²⁰, Jose L. Hernández²¹ and Ricardo Blanco²², ¹Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain, ²Hospital Universitario Marqués de Valdecilla, Santander, Spain, ³Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain, ⁴Hospital Universitario de la Princesa, Madrid, Spain, ⁵Rheumatology, Hospital Universitario de León, León, Spain, ⁶Hospital Universitario de Bellvitge, Barcelona, Spain, ⁷Hospital Universitario de Navarra, Pamplona, Spain, ⁸Hospital Universitario de Donostia. San Sebastián, Spain., Donosti, Spain, ⁹CHU Vigo, O Carballino, Spain, ¹⁰Department of Rheumatology, Hospital Sierrallana, Torrelavega, Torrelavega, Spain, ¹¹Rheumatology, Hospital General Universitario Alicante, Alicante, Spain, ¹²Complexo Hospitalario Universitario, Pontevedra, Spain, ¹³Unit of Systemic Autoimmune Diseases, Hospital San Cecilio, Granada, Spain, ¹⁴Hospital Universitario La Paz, Madrid, Spain, ¹⁵Basurto University Hospital, Bilbao, Spain, ¹⁶Elda General University Hospital, Elda, Spain, ¹⁷Rheumatology department, Complexo Hospitalario Universitario A Coruña (CHUAC). Instituto de Investigación Biomédica A Coruña (INIBIC), A Coruña, Spain, ¹⁸Parc Tauli University Hospital, Barcelona, Spain, ¹⁹Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Immunopathology Group, Santander, Spain, ²⁰Hospital Universitario Marques de Valdecilla, Santander, Spain, ²¹Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain, ²²Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain

Background/Purpose: Tocilizumab (TCZ) is the only biologic therapy approved for giant cell arteritis (GCA). Clinical trial with TCZ in GCA was performed with intravenous (iv) TCZ in a phase 2 trial (1), and with subcutaneous (sc) TCZ in the phase 3 GiACTA (2). There is general agreement on the initial/maintenance dose, but duration of TCZ therapy is not well established. In GiACTA trial, after one year on TCZ, most patients had GCA relapse after withdrawal.
This study aims to assessthe predictive factors of relapse in GCA in a clinical practice scenario.

Methods: Multicentre observational study of 471 patients with GCA. The diagnosis of GCA was performed between 2016 and 2021 according to: a) ACR criteria, and/or b) temporal artery biopsy, and/or c) imaging techniques. Relapse was defined according to EULAR consensus definition (3). From the 471 patients, we selected the patients who had available the data on relapse during follow-up. Multivariable study was conducted to identify the best set of predictors for the appearance of a relapse.

Results: GCA relapses were observed in 63 of 405 (15%) patients for whom such data was available(Table). No significant differences were observed between the two groups in demographic, clinical and laboratory characteristics or in prednisone dose at initiation of TCZ. The set of variables associated with GCA relapses were prior use of synthetic conventional disease-modifying antirheumatic drugs (scDMARDs), use of iv.TCZ, shorter time on TCZ therapy and optimization of TCZ dose (Figure).

Conclusion: GCA relapse seems related mainly to TCZ schedule and was associated with iv TCZ, and a shorter treatment time and optimization. References:

1. Villiger PM, et al. Lancet. 2016. PMID: 26952547


2. Stone JH, et al. N Engl J Med. 2017. PMID: 28745999


3. Hellmich B, et al. Ann Rheum Dis. 2020. PMID: 31270110

F. López: None; J. Loricera: None; I. Ferraz Amaro: AbbVie/Abbott, 5, 6, Amgen, 5, 6, Bristol-Myers Squibb(BMS), 6; S. Castañeda: None; C. Moriano Morales: None; J. Narvaez: None; V. Aldasoro: None; O. Maiz: None; R. Melero-Gonzalez: None; J. Villa: None; P. VELA: AbbVie/Abbott, 5, AstraZeneca, 5, Eli Lilly, 5, 6, GlaxoSmithKlein(GSK), 6, Novartis, 5, Pfizer, 5; S. Romero Yuste: AbbVie, 6, AstraZeneca, 6, Biogen, 6, Lilly, 5, 6, Pfizer, 6, Sanofi, 1; J. Callejas: None; E. De Miguel: None; E. Galindez-Agirregoikoa: None; F. Sivera: AbbVie/Abbott, 1, AstraZeneca, 5, Bristol-Myers Squibb(BMS), 5, Eli Lilly, 5, GlaxoSmithKlein(GSK), 6, Novartis, 5, 6, Pfizer, 1, Roche, 5, UCB, 6; J. Fernández López: None; A. Llobell: None; J. Sánchez-Martín: None; C. Goercke: None; L. Sanchez-Bilbao: None; J. Hernández: None; R. Blanco: AbbVie, 5, 6, Amgen, 6, AstraZeneca, 2, BMS, 6, Eli Lilly, 6, Galapagos, 2, 6, Janssen, 2, 6, MSD, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 5, 6, Sanofi, 6.