LAUSR

Background Tocilizumab (TCZ) has been shown to be effective for achieving sustained glucocorticoid (GC)-free remission in patients with giant cell arteritis (GCA) 1,2. However, data on real life patients and longterm follow up is still limited. Methods We included all patients with GCA or polymyalgia treated with TCZ iv (8 mg/kg/month) in our division from 1/2013 to 1/2018. Safety and efficacy were analysed retrospectively. Results 42 patients were analysed (69% female). Patients with involvement of cranial vessels (n=20) were older than patients without cranial involvement (n=16) (72.8±6.4 vs 63.2±10.3 years, p=0.05). Initially, 9 patients had AION, vascular stenosis was detected in 10 and aneurysms in 9 patients. Initial vascular imaging included MR/CT angiography in 36 and 14 patients, ultrasound in 23 patients and PET CT in 8 patients. Mean duration of TCZ therapy was 18.2±9.6 months with treatment ongoing in 33 patients. Since 2013, the time between diagnosis and initiation of TCZ as well as the number of immunosuppressants before TCZ decreased. All patients initially received iv methylprednisolone followed by standard oral tapering of prednisone starting with 1 mg/kg/d. PMR patients were started on oral GC. Low dose ASS or oral anticoagulants were used in 83% and statins in 55% of GCA patients. Before the first RCT of TCZ in GCA was reported3, TCZ was initiated in 25 patients after failure of conventional immunosuppressives after a mean disease duration of 12.7±11.2 months. TCZ was started after failure of one immunosuppressant in 19/25 patients, 6/25 patients failed to at least 2 immunosuppressants. Since 12/2015, 17 patients were started on TCZ with a significantly shorter disease duration (mean 4.1±5.4 months) (p=0.0047). 14/17 patients received TCZ after GC alone, in only 3 patients MTX was used before TCZ. GC free remission was achieved in 24/33 patients (73%) with ongoing TCZ treatment. GC free and TCZ free remission was achieved in 6 patients only (4/6 PMR, 2/36 patients with GCA). Therefore, a favourable outcome was noted in 30/42 patients (76.2%). In 12 patients, TCZ was stopped in patients with GC free remission. 3/11 patients relapsed after 11, 11 and 3 months and responded to reinitiation of TCZ and GC, all achieving GC free remission again. 3 GCA patients stopped TCZ in GC free remission, but died of vascular complications during follow-up. Infections during TCZ treatment included 2 patients who developed herpes zoster, one patient with RSV pneumonia and one patient with bronchitis, all occurring within the first 6 months of TCZ treatment and during concomitant GC therapy (9.5%). TCZ was reinitiated in all of these patients without subsequent complications. 3 patients developed ischaemic vascular complications (7.1%) during treatment with TCZ: 1 patient with cerebral infarction and 2 patients developed progressive vascular stenosis. Conclusions TCZ resulted in GC free remission in 76% of patients. Unfavourable events were limited to infections and vascular complications. However, sustained remission without TCZ was observed infrequently and was mainly limited to patients with PMR. Our data suggest that patients with GCA benefit from continuous treatment with TCZ. References [1] Stone JH, et al. NEJM2017;377:317. [2] Villiger PM, et al. Lancet2016;387:1921. [3] Adler S, et al. Arthritis Rheumatol2015;67(suppl 10). Disclosure of Interest None declared