{"title":"治疗巨细胞动脉炎的 Tocilizumab:复发和因不良反应停用妥昔单抗后的临床结果","authors":"Fumika N Nagase, Sho Fukui, Naoho Takizawa, Toshihiro Yamaguchi, Nobuhiro Oda, Hajime Inokuchi, Takanori Ito, Mitsuru Watanabe, Masei Suda, Yoichiro Haji, Yasuhiro Suyama, Ryo Rokutanda, Masahiro Minoda, Atsushi Nomura, Eishi Uechi, Hiromichi Tamaki","doi":"10.3899/jrheum.2024-0612","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Tocilizumab (TCZ) is effective for giant cell arteritis (GCA). However, little is known regarding treatment modification and clinical outcomes after unfavorable events such as GCA relapses or TCZ discontinuation due to adverse events (AEs).</p><p><strong>Methods: </strong>This multicenter retrospective study included patients with GCA who initiated TCZ from 2008 to 2021 at 5 Japanese hospitals. GCA relapses and TCZ-related AEs were monitored for 2 years after TCZ initiation. In patients with GCA relapses, subsequent clinical courses, including relapse symptoms and treatment modification, were followed for 90 days after the relapses. Similarly, patients who discontinued TCZ because of AEs were additionally followed until 1 year after the TCZ discontinuation to evaluate AEs, relapses, and treatment changes.</p><p><strong>Results: </strong>Of 62 eligible patients, 10 patients (16%) relapsed after initiating TCZ therapy. Most relapses (8 of 10) occurred after extending TCZ intervals or discontinuing TCZ. Combinations of adjusting TCZ intervals, adjusting glucocorticoid (GC) dose, and/or adding or increasing methotrexate (MTX) therapy could manage the relapses without serious complications. In the entire cohort, AEs occurred in 28 patients (45%), and 8 patients (13%) discontinued TCZ because of AEs. After AE-related TCZ discontinuation, 6 patients attempted to taper GCs without other immunosuppressive therapy (IST), and 4 subsequently relapsed. In contrast, 2 patients who used other IST or biologic therapy could decrease GCs without relapses.</p><p><strong>Conclusion: </strong>Although GCA relapses can occur after initiating TCZ therapy, most relapses can be safely managed by adjusting TCZ, GC, and/or MTX doses. Adding IST or biologic treatments may potentially be related to preventing relapses when patients discontinue TCZ because of AEs.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Tocilizumab (TCZ) for Giant Cell Arteritis: Clinical Outcomes Following Relapses and TCZ Discontinuation Due to Adverse Events.\",\"authors\":\"Fumika N Nagase, Sho Fukui, Naoho Takizawa, Toshihiro Yamaguchi, Nobuhiro Oda, Hajime Inokuchi, Takanori Ito, Mitsuru Watanabe, Masei Suda, Yoichiro Haji, Yasuhiro Suyama, Ryo Rokutanda, Masahiro Minoda, Atsushi Nomura, Eishi Uechi, Hiromichi Tamaki\",\"doi\":\"10.3899/jrheum.2024-0612\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Tocilizumab (TCZ) is effective for giant cell arteritis (GCA). However, little is known regarding treatment modification and clinical outcomes after unfavorable events such as GCA relapses or TCZ discontinuation due to adverse events (AEs).</p><p><strong>Methods: </strong>This multicenter retrospective study included patients with GCA who initiated TCZ from 2008 to 2021 at 5 Japanese hospitals. GCA relapses and TCZ-related AEs were monitored for 2 years after TCZ initiation. In patients with GCA relapses, subsequent clinical courses, including relapse symptoms and treatment modification, were followed for 90 days after the relapses. Similarly, patients who discontinued TCZ because of AEs were additionally followed until 1 year after the TCZ discontinuation to evaluate AEs, relapses, and treatment changes.</p><p><strong>Results: </strong>Of 62 eligible patients, 10 patients (16%) relapsed after initiating TCZ therapy. Most relapses (8 of 10) occurred after extending TCZ intervals or discontinuing TCZ. Combinations of adjusting TCZ intervals, adjusting glucocorticoid (GC) dose, and/or adding or increasing methotrexate (MTX) therapy could manage the relapses without serious complications. In the entire cohort, AEs occurred in 28 patients (45%), and 8 patients (13%) discontinued TCZ because of AEs. After AE-related TCZ discontinuation, 6 patients attempted to taper GCs without other immunosuppressive therapy (IST), and 4 subsequently relapsed. In contrast, 2 patients who used other IST or biologic therapy could decrease GCs without relapses.</p><p><strong>Conclusion: </strong>Although GCA relapses can occur after initiating TCZ therapy, most relapses can be safely managed by adjusting TCZ, GC, and/or MTX doses. Adding IST or biologic treatments may potentially be related to preventing relapses when patients discontinue TCZ because of AEs.</p>\",\"PeriodicalId\":50064,\"journal\":{\"name\":\"Journal of Rheumatology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Rheumatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3899/jrheum.2024-0612\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Rheumatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3899/jrheum.2024-0612","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
Tocilizumab (TCZ) for Giant Cell Arteritis: Clinical Outcomes Following Relapses and TCZ Discontinuation Due to Adverse Events.
Objective: Tocilizumab (TCZ) is effective for giant cell arteritis (GCA). However, little is known regarding treatment modification and clinical outcomes after unfavorable events such as GCA relapses or TCZ discontinuation due to adverse events (AEs).
Methods: This multicenter retrospective study included patients with GCA who initiated TCZ from 2008 to 2021 at 5 Japanese hospitals. GCA relapses and TCZ-related AEs were monitored for 2 years after TCZ initiation. In patients with GCA relapses, subsequent clinical courses, including relapse symptoms and treatment modification, were followed for 90 days after the relapses. Similarly, patients who discontinued TCZ because of AEs were additionally followed until 1 year after the TCZ discontinuation to evaluate AEs, relapses, and treatment changes.
Results: Of 62 eligible patients, 10 patients (16%) relapsed after initiating TCZ therapy. Most relapses (8 of 10) occurred after extending TCZ intervals or discontinuing TCZ. Combinations of adjusting TCZ intervals, adjusting glucocorticoid (GC) dose, and/or adding or increasing methotrexate (MTX) therapy could manage the relapses without serious complications. In the entire cohort, AEs occurred in 28 patients (45%), and 8 patients (13%) discontinued TCZ because of AEs. After AE-related TCZ discontinuation, 6 patients attempted to taper GCs without other immunosuppressive therapy (IST), and 4 subsequently relapsed. In contrast, 2 patients who used other IST or biologic therapy could decrease GCs without relapses.
Conclusion: Although GCA relapses can occur after initiating TCZ therapy, most relapses can be safely managed by adjusting TCZ, GC, and/or MTX doses. Adding IST or biologic treatments may potentially be related to preventing relapses when patients discontinue TCZ because of AEs.
期刊介绍:
The Journal of Rheumatology is a monthly international serial edited by Earl D. Silverman. The Journal features research articles on clinical subjects from scientists working in rheumatology and related fields, as well as proceedings of meetings as supplements to regular issues. Highlights of our 41 years serving Rheumatology include: groundbreaking and provocative editorials such as "Inverting the Pyramid," renowned Pediatric Rheumatology, proceedings of OMERACT and the Canadian Rheumatology Association, Cochrane Musculoskeletal Reviews, and supplements on emerging therapies.