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.

• 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