Relapse after cessation of weekly tocilizumab for giant cell arteritis: a multicentre service evaluation in England-Reference-Cited by-同舟云学术

Relapse after cessation of weekly tocilizumab for giant cell arteritis: a multicentre service evaluation in England

Published:2023-11-11 Issue: Volume: Page:
ISSN:1462-0324
Container-title:Rheumatology
language:en
Short-container-title:

Author:

Quick Vanessa¹^ORCID,Abusalameh Mahdi²^ORCID,Ahmed Sajeel³,Alkoky Hoda¹,Bukhari Marwan⁴⁵^ORCID,Carter Stuart⁶^ORCID,Coath Fiona L⁷^ORCID,Davidson Brian⁸,Doddamani Parveen⁹,Dubey Shirish¹⁰¹¹^ORCID,Ducker Georgina¹²^ORCID,Griffiths Bridget³^ORCID,Gullick Nicola¹³¹⁴^ORCID,Heaney Jonathan³,Holloway Amelia¹⁵^ORCID,Htut Ei Ei Phyu¹⁶,Hughes Mark¹⁷^ORCID,Irvine Hannah¹⁰,Kinder Alison⁹,Kurshid Asim¹⁸,Lim Joyce¹⁹^ORCID,Ludwig Dalia R²⁰,Malik Mariam⁸,Mercer Louise²¹,Mulhearn Ben²²²³^ORCID,Nair Jagdish R²⁴²⁵^ORCID,Patel Rikesh²⁶,Robson Joanna²⁷²⁸^ORCID,Saha Pratyasha¹²^ORCID,Tansley Sarah²²²³^ORCID,Ahmed Saad,Atchia Ismael,Bluett James,Connew Alex,Coulson Elizabeth,Crawshaw Helena,Davies Ursula,De Lord Denise,Dulay Gurdeep,Embuldeniya Amanda,Fonseca Carmen,Galloway James,Gubbins William,Guruparan Thushyanthan,Heaton Rebecca,James Martin,Janagan Shalini,Johnson Hilary,Karim Areej,Khalid Salema,Kinsey Kath,Koduri Gouri,Linton Stuart,MacPhie Elizabeth,Mahto Arti,Mukhtyar Chetan,Nandagudi Anupama C,Nandi Pradip,Osman Fathelrahman,Plumb Sophie,Quinlan Eavan,Redfern Angela,Regan Marian,Reid Vanessa,Roy Dipak,Saeed Sadaf,Smith Abbey,Steel Lauren,Thomas Rhys,Ugwoke Adaeze,Villar Sarah,Williams Emma,Wood Fiona,Xie Mingrui,Mackie Sarah L¹⁹²⁹^ORCID,

Affiliation:

1. Rheumatology Department, Luton and Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust , Bedford, UK

2. Rheumatology Department, Royal Devon University Healthcare NHS Foundation Trust , Devon, UK

3. Rheumatology Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle, UK

4. Lancaster University , Lancaster, UK

5. Rheumatology Department, Royal Lancaster Infirmary , Lancaster, UK

6. Rheumatology Department, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield, UK

7. Rheumatology Department, Southend University Hospital NHS Trust , Southend, UK

8. Rheumatology Department, University Hospital Southampton NHS Foundation Trust , Southampton, UK

9. Rheumatology Department, University Hospitals of Leicester NHS Trust , Leicester, UK

10. Department of Rheumatology, Oxford University Hospitals NHS Foundation Trust , Oxford, UK

11. Nuffield Dept of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford, UK

12. Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust , Norwich, UK

13. Rheumatology Department, University Hospitals Coventry & Warwickshire NHS Trust , Coventry, UK

14. Rheumatology Department, Coventry & Warwick Medical School, University of Warwick , Warwick, UK

15. Rheumatology Department, Kings College Hospital NHS Foundation Trust , London, UK

16. Department of Rheumatology, Addenbrooke’s Hospital, Cambridge University Hospitals , Cambridge, UK

17. Rheumatology Department, Royal Cornwall Hospitals NHS Trust , Cornwall, UK

18. Rheumatology Department, University Hospitals Dorset NHS Foundation Trust , Poole, UK

19. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds , Leeds, UK

20. Rheumatology Department, University College London NHS Foundation Trust , London, UK

21. Rheumatology Department, Stockport NHS Foundation Trust , Stockport, UK

22. Department of Life Sciences, University of Bath , Bath, UK

23. Royal United Hospital for Rheumatic Diseases, Royal United Hospitals Bath , Bath, UK

24. Rheumatology Department, Liverpool University Hospitals (Aintree) , Liverpool, UK

25. The National Behcet’s Centre of Excellence , Liverpool, UK

26. Rheumatology Department, Manchester University Foundation NHS Trust, Manchester Royal Infirmary , Manchester, UK

27. Centre for Health and Clinical Research, University of the West of England , Bristol, UK

28. Department of Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust , Bristol, UK

29. NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust , Leeds, UK

Abstract

Abstract Objectives The National Health Service in England funds 12 months of weekly s.c. tocilizumab (qwTCZ) for patients with relapsing or refractory GCA. During the coronavirus disease 2019 (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 A total of 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% 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 years, 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.

Publisher

Oxford University Press (OUP)

Subject

Pharmacology (medical),Rheumatology

Link

https://academic.oup.com/rheumatology/advance-article-pdf/doi/10.1093/rheumatology/kead604/53812340/kead604.pdf

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