Effectiveness of a 26-week glucocorticoid taper in giant cell arteritis treated with tocilizumab in real-world clinical practice: a single-centre cohort study.

Abstract

Objective: To assess the feasibility of the Giant Cell Arteritis Actemra (GiACTA)-based 26-week glucocorticoid (GC) taper in patients with newly diagnosed GCA.

Methods: We conducted a retrospective, single-centre study including patients with newly diagnosed active GCA treated with tocilizumab (TCZ) and GCs, GC monotherapy or GCs combined with conventional DMARDs. In all patients treated with TCZ the standard GC taper was the GiACTA-based 26-week GC taper. A subgroup of TCZ-treated patients at high risk for GC-associated adverse events was identified, in which, based on a decision between the patient and physician, a shorter 16-week prednisone taper was used. Data on relapses, steroid doses and therapy-related adverse events were collected from patients' records.

Results: A total of 101 patients with newly diagnosed GCA were included; 47 (46.5%) patients were treated from the beginning with TCZ. Of the 47 patients, 28 (59.6%) treated with TCZ tapered off GCs completely within 26 weeks. Of these patients off GCs within 26 weeks, 25 (89.3%) were in relapse-free remission at week 52. In 15 patients treated with TCZ, GCs were tapered off completely within 16 weeks. Of these patients off GCs within 16 weeks, 14 (93.3%) were still in relapse-free remission at week 52 and no further flares occurred in this group of patients by week 104. No case of GCA-related vision loss or cerebrovascular ischaemia occurred during follow-up.

Conclusion: In this real-world setting, 26- and 16-week GC tapers were effective and safe in patients with newly diagnosed GCA treated with TCZ.