LAUSR

Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are closely related inflammatory conditions affecting people aged over 50 years.We present our experience of using tocilizumab (TCZ) therapy for management of GCA/PMR aggravated by severe concurrent pathologies that potentially increase the risk of side effects of glucocorticoids (GCs).22 patients were recruited into the prospective study: six patients with GCA, 13- PMR, and three- with both GCA and PMR, 95.5% were females, mean age 72.8±6.5 years. Mean disease duration was 3.5 (0.5-19) months. All patients had active GCA/PMR with mean CRP 30.3±32.7 mg/l. Seven patients had visual ischemic complications, and another one- aortitis. All patients had serious comorbidities, 59% of patients had three and more severe concurrent diseases. All patients were administered TCZ i/v 2.3-8.8 mg/kg Q4W. 50% patients were also treated with prednisone at mean 20 (10-70) mg/day. The follow-up period was 24 (6-60) months.All patients demonstrated good clinical response to TCZ i/v 2.3-8.8 mg/kg Q4W given for average 4,5 (2-11) months, achieving remission in 100% of cases. Some patients showed a very rapid improvement after initiation of treatment, including TCZ monotherapy. Prednisone dose was discontinued in 6/11, or was reduced to 2.5 (2.5-10) mg in 4/11. There was one relapse after TCZ discontinuation, although this patient managed to regain the remission after resumption of TCZ i/v 4 mg/kg. There was one (4.6%) serious complication (septic olecranon bursitis 1 month after TCZ discontinuation), one patient died of myocardial infarction 12 months later after TCZ discontinuation. Three remaining complications included one case of peripheral artery disease (claudication), one- psoriasis, and one- sural lipodermatosclerosis.Interleukin-6 inhibitors should be considered as potentially effective and relatively safe treatment for GCA/PMR patients with serious comorbidities, intolerance or contraindications to standard therapy. More data is necessary to identify the optimal dosing regimen and duration of TCZ therapy, as well as cost-effectiveness aspects.None declared