Relapse after cessation of weekly tocilizumab for giant cell arteritis: A multicentre service evaluation in England

Quick, Vanessa; Abusalameh, Mahdi; Ahmed, Sajeel; Alkoky, Hoda; Bukhari, Marwan; Carter, Stuart; Coath, Fiona L; Davidson, Brian; Doddamani, Parveen; Dubey, Shirish; Ducker, Georgina; Griffiths, Bridget; Gullick, Nicola; Heaney, Jonathan; Holloway, Amelia; Htut, Ei Ei Phyu; Hughes, Mark; Irvine, Hannah; Kinder, Alison; Kurshid, Asim; Lim, Joyce; Ludwig, Dalia R; Malik, Mariam; Mercer, Louise; Mulhearn, Ben; Nair, Jagdish R; Patel, Rikesh; Robson, Joanna; Saha, Pratyasha; Tansley, Sarah; TOC STOP 2022 Investigators; Mackie, Sarah L

Abstract

Objectives: The National Health Service in England funds 12 months of weekly subcutaneous tocilizumab (qwTCZ) for patients with relapsing or refractory giant cell arteritis (GCA). During the COVID-19 pandemic, some patients were allowed longer treatment. We sought to describe what happened to patients after cessation of qwTCZ.

Methods: Multicentre service evaluation of relapse after stopping qwTCZ for GCA. The log-rank test was used to identify significant differences in time to relapse.

Results: 336 GCA patients were analysed from 40 centres, treated with qwTCZ for a median (interquartile range, IQR) of 12 (12-17) months. At time of stopping qwTCZ, median (IQR) prednisolone dose was 2 (0-5) mg/day. By 6, 12 and 24 months after stopping qwTCZ, 21.4%, 35.4% and 48.6% respectively had relapsed, requiring an increase in prednisolone dose to a median (IQR) of 20 (10-40) mg/day. 33.6% of relapsers had a major relapse as defined by EULAR. Time to relapse was shorter in those that had previously also relapsed during qwTCZ treatment (P = 0.0017); in those not in remission at qwTCZ cessation (P = 0.0036); and in those with large vessel involvement on imaging (P = 0.0296). Age ≥65, gender, GCA-related sight loss, qwTCZ treatment duration, TCZ taper, prednisolone dosing, and conventional synthetic DMARD use were not associated with time to relapse.

Conclusion: Up to half our patients with GCA relapsed after stopping qwTCZ, often requiring a substantial increase in prednisolone dose. One third of relapsers had a major relapse. Extended use of TCZ or repeat treatment for relapse should be considered for these patients.

Citation

Quick, V., Abusalameh, M., Ahmed, S., Alkoky, H., Bukhari, M., Carter, S., …Mackie, S. L. (in press). Relapse after cessation of weekly tocilizumab for giant cell arteritis: A multicentre service evaluation in England. Rheumatology, https://doi.org/10.1093/rheumatology/kead604

• Journal Article Type: Article
• Acceptance Date: Nov 1, 2023
• Online Publication Date: Nov 11, 2023
• Deposit Date: Feb 13, 2024
• Publicly Available Date: Nov 12, 2024
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1093/rheumatology/kead604
• Keywords: NICE guidance; giant cell arteritis; relapse; service evaluation; tocilizumab; vasculitis
• Public URL: https://uwe-repository.worktribe.com/output/11700385