Better Outcomes with Combo Treatment for Giant Cell Arteritis

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Patients with giant cell arteritis treated weekly or bi-weekly with tocilizumab and a prednisone taper experience better outcomes than those treated only with prednisone, a new study shows.

Research published recently in Arthritis Research & Therapy reported that these patients have improved health-related quality of life (HRQOL) and less fatigue than patients treated with a placebo and prednisone tapering. The results, investigators said, are significant.

The study included 251 patients over age 50 years who had newly diagnosed or relapsing active giant cell arteritis and a history of elevated erythrocyte sedimentation rate due to giant cell arteritis. Participants were randomly assigned to one of four protocols: (1) weekly subcutaneous tocilizumab 162 mg plus a 26-week prednisone taper (2) every-other-week subcutaneous tocilizumab 162 mg plus a 26-week prednisone taper (3) weekly subcutaneous placebo plus a 26-week prednisone taper or (4) placebo plus a 52-week prednisone taper.

After a year, investigators analyzed primary outcomes (sustained disease remission at 52 weeks) and secondary and patient-reported outcomes. Patient reported outcomes included physical function, role physical, bodily pain, general health, vitality, social function, role emotional and mental health.

Patients who received weekly subcutaneous tocilizumab 162 mg plus a 26-week prednisone taper reported statistically significantly better outcomes and improvements in fatigue than participants in the other groups.

“These findings are unprecedented in other HRQOL analyses across rheumatic diseases and highlight the importance of IL-6 in the underlying pathophysiology of giant cell arteritis,” researchers said.

The weekly subcutaneous tocilizumab with 26-week prednisone taper group also experienced “consistent and unequivocal improvements” in quality of life measures compared to placebo groups.

REFERENCE

Strand V, Dimonaco S, Tuckwell K, Klearman M, Collinson N, Stone J, Health-related quality of life in patients with giant cell arteritis with tocilizumab in a phase 3 randomized controlled trial. Arthritis Research & Therapy (2019), doi:10.1186/s13075-019-1837-7.