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Kawka L, Chevet B, Arnaud L, Becker G, Carvajal Alegria G, Felten R. The pipeline of immunomodulatory therapies in polymyalgia rheumatica and giant cell arteritis: A systematic review of clinical trials. Autoimmun Rev 2024; 23:103590. [PMID: 39122202 DOI: 10.1016/j.autrev.2024.103590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/01/2024] [Accepted: 08/04/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION The objective of this systematic review was to provide an overview of current developments and potentially available therapeutic options for polymyalgia rheumatic (PMR) and giant cell arteritis (GCA), in the coming years. METHODS We conducted a systematic review of 17 national and international clinical trial databases for all disease-modifying anti-rheumatic drugs (DMARDs) for PMR and GCA that are already marketed, in clinical development or withdrawn. The search was performed on January 2024, with the keywords "polymyalgia rheumatica" and "giant cell arteritis". For each molecule, we only considered the study at the most advanced stage of clinical development. RESULTS For PMR, a total of 15 DMARDs were identified: 2 conventional synthetic DMARDs (csDMARDs), 11 biologic DMARDs (bDMARDs) and 2 targeted synthetic DMARDs (tsDMARDs). For GCA, 18 DMARDs were identified: 2 csDMARDs, 14 bDMARDs and 2 tsDMARDs. Currently, there are only 2 approved corticosteroid-sparing therapies in these diseases, which both target the IL-6 signaling pathway, namely tocilizumab in GCA and sarilumab in PMR. Most of the molecules in current development are repurposed from from other conditions and clinical research in PMR/GCA seems to be mostly driven by the potential to repurpose existing treatments rather than by translational research. CONCLUSION This systematic review identified 23 DMARDs evaluated for PMR and GCA: 3 csDMARDs, 17 bDMARDs and 3 tsDMARDs. Several promising treatments are likely to be marketed in the coming years.
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Affiliation(s)
- Lou Kawka
- Service de Rhumatologie, Centre National de Référence des Maladies Auto-immunes et Systémiques Rares (RESO), Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France
| | - Baptiste Chevet
- UMR 1227 Lymphocytes B et auto-immunité, université de Brest, Inserm, CHU de Brest, Brest, France; Service de Rhumatologie, Hôpital de la Cavale Blanche, CHU de Brest, Bd Tanguy-Prigent, 29200 Brest, France
| | - Laurent Arnaud
- Service de Rhumatologie, Centre National de Référence des Maladies Auto-immunes et Systémiques Rares (RESO), Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France
| | - Guillaume Becker
- Pôle Pharmacie-Pharmacologie, Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France; Département Universitaire de Pharmacologie, Addictologie, Toxicologie et Thérapeutique (DUPATT), Université de Strasbourg, Strasbourg, France
| | | | - Renaud Felten
- Service de Rhumatologie, Centre National de Référence des Maladies Auto-immunes et Systémiques Rares (RESO), Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France; Département Universitaire de Pharmacologie, Addictologie, Toxicologie et Thérapeutique (DUPATT), Université de Strasbourg, Strasbourg, France; Center for Clinical Investigation, INSERM U1434, Strasbourg, France.
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Martín-Gutiérrez A, Loricera J, Narváez J, Aldasoro V, Maiz O, Vela P, Romero-Yuste S, de Miguel E, Galíndez-Agirregoikoa E, Fernández-López JC, Ferraz-Amaro I, Sánchez-Martín J, Moya P, Campos C, López-Gutiérrez F, Castañeda S, Blanco R. Effectiveness Of Tocilizumab In Aortitis And Aneurysms Associated With Giant Cell Arteritis. Eur J Intern Med 2024:S0953-6205(24)00253-X. [PMID: 38908981 DOI: 10.1016/j.ejim.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE Aortitis in Giant Cell Arteritis (GCA-aortitis) is a frequent complication that may lead to aneurysms. Tocilizumab (TCZ) was approved in GCA, but the efficacy in GCA-aortitis and aneurysms has not been analyzed to date. Our aim was to assess the effectiveness and safety of TCZ in a wide series of GCA-aortitis and aneurysms. METHODS Multicentre observational study with GCA-aortitis treated with TCZ. GCA was diagnosed by: a) ACR criteria, b) temporal artery biopsy, and/or c) imaging techniques. Aortitis was diagnosed mainly by PET/CT. Main outcomes were EULAR and imaging remission. Others were clinical remission, analytical normalization, corticosteroid-sparing effect, and the prevention and improvement of aneurysms. RESULTS 196 patients with GCA-aortitis treated with TCZ. After 6 months, 72.2% reached EULAR remission but only 12% an imaging remission; increasing up-to 81.4% and 31.8%, respectively, at 24 months. A rapid clinical remission, ESR and CRP normalization was observed in 47.4%, 84.3% and 55.6%, at 1 month, increasing to 89.6%, 85.3% and 80.3% at 24 months, respectively. Aneurysms were present in 10 (5%) patients. Five of them required early surgery, while 3 others enlarged. No patient on TCZ therapy developed aneurysms during follow-up. CONCLUSION In patients with GCA-aortitis treated with TCZ, a rapid and maintained clinical and analytical improvement was observed. However, there was an uncoupling between clinical and EULAR remission with imaging remission.
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Affiliation(s)
- Adrián Martín-Gutiérrez
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Immunopathology Group, Santander, Spain
| | - Javier Loricera
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Immunopathology Group, Santander, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain
| | - Vicente Aldasoro
- Department of Rheumatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Olga Maiz
- Department of Rheumatology, Hospital Universitario de Donosti, San Sebastián, Spain
| | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Susana Romero-Yuste
- Department of Rheumatology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Eugenio de Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Iván Ferraz-Amaro
- Department of Rheumatology, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | | | - Patricia Moya
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina Campos
- Department of Rheumatology, Hospital General Universitatio de Valencia, Valencia, Spain
| | - Fernando López-Gutiérrez
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Immunopathology Group, Santander, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Catedra EPID-Future, UAM, Madrid, Spain
| | - Ricardo Blanco
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Immunopathology Group, Santander, Spain.
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Samec MJ, Rakholiya J, Langenfeld H, Crowson CS, Abril A, Wang B, Mertz L, Rodriguez-Pla A, Bansal P, Burke M, Jaquith J, Weyand C, Warrington KJ, Koster MJ. Relapse Risk and Safety of Long-Term Tocilizumab Use Among Patients With Giant Cell Arteritis: A Single-Enterprise Cohort Study. J Rheumatol 2023; 50:1310-1317. [PMID: 37321636 PMCID: PMC10543396 DOI: 10.3899/jrheum.2022-1214] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of tocilizumab (TCZ) in giant cell arteritis (GCA) in a large North American cohort. METHODS Patients with GCA treated with TCZ between January 1, 2010, and May 15, 2020, were retrospectively identified. Kaplan-Meier methods were used to estimate time to TCZ discontinuation and time to first relapse after TCZ discontinuation. Poisson regression models were used to compare annualized relapse rates before, during, and after TCZ use. Age- and sex-adjusted risk factors associated with relapse on and off TCZ and development of adverse events of significant interest (AESIs) were examined using Cox models. RESULTS One hundred fourteen patients (60.5% female) were included with mean (SD) age 70.4 (8.2) years. Median duration from GCA diagnosis to TCZ start was 4.5 months. Median overall duration of TCZ treatment was 2.3 years. Relapse rate prior to TCZ start (0.84 relapses/person-year) was 3-fold reduced while on TCZ (0.28 relapses/person-year; P < 0.001) but increased to 0.64 relapses/person-year after TCZ discontinuation. Fifty-two patients stopped TCZ after a median of 16.8 months; 27 relapsed after discontinuation (median: 8.4 months; 58% relapsed within 12 months). Only 14.9% of patients stopped TCZ because of AESIs. Neither dose/route of TCZ, presence of large-vessel vasculitis, nor duration of TCZ therapy prior to discontinuation predicted relapse after TCZ stop. CONCLUSION TCZ is well tolerated in GCA, with low rates of discontinuation for AESIs. However, relapse occurred in > 50% despite median treatment > 12 months. Since the duration of TCZ prior to discontinuation did not significantly affect subsequent risk of GCA recurrence, further research is needed to determine the optimal duration of therapy.
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Affiliation(s)
- Matthew J Samec
- M.J. Samec, MD, J. Rakholiya, MBBS, M. Burke, APRN, CNP, J. Jaquith, CCRC, C. Weyand, MD, PhD, K.J. Warrington, MD, M.J. Koster, MD, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota
| | - Jigisha Rakholiya
- M.J. Samec, MD, J. Rakholiya, MBBS, M. Burke, APRN, CNP, J. Jaquith, CCRC, C. Weyand, MD, PhD, K.J. Warrington, MD, M.J. Koster, MD, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota
| | - Hannah Langenfeld
- H. Langenfeld, MPH, Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Cynthia S Crowson
- C.S. Crowson, PhD, Division of Rheumatology, and Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Andy Abril
- A. Abril, MD, B. Wang, MD, Division of Rheumatology, Mayo Clinic, Jacksonville, Florida
| | - Benjamin Wang
- A. Abril, MD, B. Wang, MD, Division of Rheumatology, Mayo Clinic, Jacksonville, Florida
| | - Lester Mertz
- L. Mertz, MD, A. Rodriguez-Pla, MD, PhD, Division of Rheumatology, Mayo Clinic, Scottsdale, Arizona
| | - Alicia Rodriguez-Pla
- L. Mertz, MD, A. Rodriguez-Pla, MD, PhD, Division of Rheumatology, Mayo Clinic, Scottsdale, Arizona
| | - Pankaj Bansal
- P. Bansal, MBBS, Division of Rheumatology, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Michelle Burke
- M.J. Samec, MD, J. Rakholiya, MBBS, M. Burke, APRN, CNP, J. Jaquith, CCRC, C. Weyand, MD, PhD, K.J. Warrington, MD, M.J. Koster, MD, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota
| | - Jane Jaquith
- M.J. Samec, MD, J. Rakholiya, MBBS, M. Burke, APRN, CNP, J. Jaquith, CCRC, C. Weyand, MD, PhD, K.J. Warrington, MD, M.J. Koster, MD, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota
| | - Cornelia Weyand
- M.J. Samec, MD, J. Rakholiya, MBBS, M. Burke, APRN, CNP, J. Jaquith, CCRC, C. Weyand, MD, PhD, K.J. Warrington, MD, M.J. Koster, MD, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota
| | - Kenneth J Warrington
- M.J. Samec, MD, J. Rakholiya, MBBS, M. Burke, APRN, CNP, J. Jaquith, CCRC, C. Weyand, MD, PhD, K.J. Warrington, MD, M.J. Koster, MD, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota
| | - Matthew J Koster
- M.J. Samec, MD, J. Rakholiya, MBBS, M. Burke, APRN, CNP, J. Jaquith, CCRC, C. Weyand, MD, PhD, K.J. Warrington, MD, M.J. Koster, MD, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota;
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Carvajal Alegria G, Nicolas M, van Sleen Y. Biomarkers in the era of targeted therapy in giant cell arteritis and polymyalgia rheumatica: is it possible to replace acute-phase reactants? Front Immunol 2023; 14:1202160. [PMID: 37398679 PMCID: PMC10313393 DOI: 10.3389/fimmu.2023.1202160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
Research into giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) has become more important in the last few decades. Physicians are facing several challenges in managing the diagnosis, treatment, and relapses of GCA and PMR patients. The search for biomarkers could provide elements to guide a physician's decision. In this review, we aim to summarize the scientific publications about biomarkers in GCA and PMR in the past decade. The first point raised by this review is the number of clinical situations in which biomarkers could be useful: differential diagnosis of either GCA or PMR, diagnosis of underlying vasculitis in PMR, prediction of relapse or complications, disease activity monitoring, choice, and modification of treatments. The second point raised by this review is the large number of biomarkers studied, from common markers like C-reactive protein, erythrocyte sedimentation rate, or elements of blood count to inflammatory cytokines, growth factors, or immune cell subpopulations. Finally, this review underlines the heterogeneity between the studies and proposes points to consider in studies evaluating biomarkers in general and particularly in the case of GCA and PMR.
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Affiliation(s)
- Guillermo Carvajal Alegria
- EA6295 Nanomédicaments et Nanosondes, Université de Tours, Tours, France
- Department of Rheumatology, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours Cedex, France
| | - Mathilde Nicolas
- Department of Rheumatology, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours Cedex, France
| | - Yannick van Sleen
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, Netherlands
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Correia JA, Crespo J, Alves G, Salvador F, Matos-Costa J, Alves JD, Fortuna J, Almeida I, Campar A, Brandão M, Faria R, Marado D, Oliveira S, Santos L, Silva F, Vasconcelos C, Fernandes M, Marinho A. Biologic therapy in large and small vessels vasculitis, and Behçet's disease: Evidence- and practice-based guidance. Autoimmun Rev 2023:103362. [PMID: 37230310 DOI: 10.1016/j.autrev.2023.103362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/21/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Vasculitis are a very heterogenous group of systemic autoimmune diseases, affecting large vessels (LVV), small vessels or presenting as a multisystemic variable vessel vasculitis. We aimed to define evidence and practice-based recommendations for the use of biologics in large and small vessels vasculitis, and Behçet's disease (BD). METHODS Recommendations were made by an independent expert panel, following a comprehensive literature review and two consensus rounds. The panel included 17 internal medicine experts with recognized practice on autoimmune diseases management. The literature review was systematic from 2014 until 2019 and later updated by cross-reference checking and experts' input until 2022. Preliminary recommendations were drafted by working groups for each disease and voted in two rounds, in June and September 2021. Recommendations with at least 75% agreement were approved. RESULTS A total of 32 final recommendations (10 for LVV treatment, 7 for small vessels vasculitis and 15 for BD) were approved by the experts and several biologic drugs were considered with different supporting evidence. Among LVV treatment options, tocilizumab presents the higher level of supporting evidence. Rituximab is recommended for treatment of severe/refractory cryoglobulinemic vasculitis. Infliximab and adalimumab are most recommended in treatment of severe/refractory BD manifestations. Other biologic drugs can be considered is specific presentations. CONCLUSION These evidence and practice-based recommendations are a contribute to treatment decision and may, ultimately, improve the outcome of patients living with these conditions.
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Affiliation(s)
- João Araújo Correia
- Serviço de Medicina Interna, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal; Unidade de Imunologia Clínica, Departamento de Medicina, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Jorge Crespo
- Serviço de Medicina Interna, Departamento de Medicina, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Glória Alves
- Serviço de Medicina Interna, Hospital da Senhora da Oliveira, Centro Hospitalar Alto Ave, Rua dos Cutileiros 4810-055, Guimarães, Portugal
| | - Fernando Salvador
- Unidade de Doenças Autoimunes, Serviço de Medicina Interna, Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, 5000-508 Vila Real, Portugal
| | - João Matos-Costa
- Serviço de Medicina Interna, Hospital Distrital de Santarém, Avenida Bernardo Santareno, 2005-177 Santarém,Portugal
| | - José Delgado Alves
- Systemic Autoimmune Diseases Unit, Hospital Prof. Doutor Fernando Fonseca, IC19 - 2720-276, Amadora, Portugal; 4Immune Response and Vascular Disease Unit - iNOVA4Health, NOVA Medical School; R. Câmara Pestana 6, 1150-082 Lisboa, Portugal
| | - Jorge Fortuna
- Serviço de Medicina Interna, Departamento de Medicina, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Isabel Almeida
- Unidade de Imunologia Clínica, Departamento de Medicina, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Ana Campar
- Unidade de Imunologia Clínica, Departamento de Medicina, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Mariana Brandão
- Unidade de Imunologia Clínica, Departamento de Medicina, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Raquel Faria
- Unidade de Imunologia Clínica, Departamento de Medicina, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Daniela Marado
- Serviço de Medicina Interna, Departamento de Medicina, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Susana Oliveira
- Systemic Autoimmune Diseases Unit, Hospital Prof. Doutor Fernando Fonseca, IC19 - 2720-276, Amadora, Portugal
| | - Lelita Santos
- Serviço de Medicina Interna, Departamento de Medicina, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, R. Larga 2, 3000-370 Coimbra, Portugal; CIMAGO, Faculdade de Medicina da Universidade de Coimbra, R. Larga 2, 3000-370 Coimbra, Portugal
| | - Fátima Silva
- Serviço de Medicina Interna, Departamento de Medicina, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Carlos Vasconcelos
- Unidade de Imunologia Clínica, Departamento de Medicina, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Milene Fernandes
- RWE & Late Phase, CTI Clinical Trial & Consulting Services Unipessoal Lda, R. Tierno Galvan, 1250-096 Lisboa, Portugal
| | - António Marinho
- Unidade de Imunologia Clínica, Departamento de Medicina, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal.
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Mainbourg S, Tabary A, Cucherat M, Gueyffier F, Lobbes H, Aussedat M, Grenet G, Durieu I, Samson M, Lega JC. Indirect Comparison of Glucocorticoid-Sparing Agents for Remission Maintenance in Giant Cell Arteritis: A Network Meta-analysis. Mayo Clin Proc 2022; 97:1824-1835. [PMID: 35995627 DOI: 10.1016/j.mayocp.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare and rank the effect of glucocorticoid-sparing agents in giant cell arteritis (GCA), for which several drugs have been evaluated but with a benefit-risk balance that remains uncertain. METHODS The MEDLINE and Clinical Trials databases were searched up to November 2021; all randomized controlled trials investigating glucocorticoids in GCA were included. The glucocorticoid regimen was dichotomized into short (≤6 months) or prolonged (>6 months) use. Risk of relapse and safety were estimated using network meta-analysis with frequentist random effects models. RESULTS Of the 96 records screened, 8 trials were included (572 patients). The trials compared glucocorticoids and a sparing agent: tocilizumab (2 trials), oral methotrexate (3 trials), infliximab (1 trial), etanercept (1 trial), and adalimumab (1 trial). The pooled prevalence of GCA relapse was 52.6% (95% CI, 38.1 to 66.9). The risk of relapse was significantly lower with tocilizumab compared with methotrexate (relative risk [RR], 0.41; 95% CI, 0.17 to 0.97) and prolonged (RR, 0.41; 95% CI, 0.20 to 0.83) and short (RR, 0.32; 95% CI, 0.16 to 0.66) glucocorticoid use. The risk of relapse was not significantly different with methotrexate compared with short (RR, 0.79; 95% CI, 0.48 to 1.31) and prolonged (RR, 0.95; 95% CI, 0.31 to 2.89) glucocorticoid use. The frequency of serious adverse events and serious infection was comparable between the different drugs. The certainty of the evidence was low to very low. CONCLUSION This meta-analysis suggests that tocilizumab may be superior to other sparing agents to prevent GCA relapse, but with a low to very low certainty of evidence, and that safety is comparable to the other drugs. REGISTRATION The protocol of the meta-analysis is registered in the international prospective register of systematic reviews PROSPERO (https://www.crd.york.ac.uk/prospero/; registration CRD42020112387).
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Affiliation(s)
- Sabine Mainbourg
- Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Lyon immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France.
| | - Axel Tabary
- Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Michel Cucherat
- Service de pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France
| | - François Gueyffier
- Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France
| | - Hervé Lobbes
- Service de médecine interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie Aussedat
- Service de court séjour gériatrique, Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France
| | - Guillaume Grenet
- Service de pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France
| | - Isabelle Durieu
- Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Université de Lyon, Université Lyon 1, Health Services and Performance Research EA7425, Lyon, France
| | - Maxime Samson
- Service de médecine interne et d'immunologie clinique, CHU Dijon Bourgogne, Hôpital François Mitterrand, Dijon, France
| | - Jean Christophe Lega
- Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Lyon immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France
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Advances in the Treatment of Giant Cell Arteritis. J Clin Med 2022; 11:jcm11061588. [PMID: 35329914 PMCID: PMC8954453 DOI: 10.3390/jcm11061588] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/23/2022] [Accepted: 03/10/2022] [Indexed: 11/25/2022] Open
Abstract
Giant cell arteritis (GCA) is the most common vasculitis among elderly people. The clinical spectrum of the disease is heterogeneous, with a classic/cranial phenotype, and another extracranial or large vessel phenotype as the two more characteristic patterns. Permanent visual loss is the main short-term complication. Glucocorticoids (GC) remain the cornerstone of treatment. However, the percentage of relapses with GC alone is high, and the rate of adverse events affects more than 80% of patients, so it is necessary to have alternative therapeutic options, especially in patients with worse prognostic factors or high comorbidity. MTX is the only DMARD that has shown to reduce the cumulative dose of GC, while tocilizumab is the first biologic agent approved due to its ability to decrease the relapse rate and lower the cumulative GC doses. However, apart from the IL-6 pathway, there are other pro-inflammatory cytokines and growth factors involved in the typical intima hyperplasia and vascular remodeling of GCA. Among them, the more promising targets in GCA treatment are the IL12/IL23 axis antagonists, IL17 inhibitors, modulators of T lymphocytes, and inhibitors of either the JAK/STAT pathway, the granulocyte-macrophage colony-stimulating factor, or the endothelin, all of which are updated in this review.
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Tomelleri A, van der Geest KSM, Sebastian A, van Sleen Y, Schmidt WA, Dejaco C, Dasgupta B. Disease stratification in giant cell arteritis to reduce relapses and prevent long-term vascular damage. THE LANCET RHEUMATOLOGY 2021. [DOI: 10.1016/s2665-9913(21)00277-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Samson M, Greigert H, Ciudad M, Gerard C, Ghesquière T, Trad M, Corbera-Bellalta M, Genet C, Ouandji S, Cladière C, Thebault M, Ly KH, Liozon E, Maurier F, Bienvenu B, Terrier B, Guillevin L, Charles P, Quipourt V, Devilliers H, Gabrielle PH, Creuzot-Garcher C, Tarris G, Martin L, Saas P, Audia S, Cid MC, Bonnotte B. Improvement of Treg immune response after treatment with tocilizumab in giant cell arteritis. Clin Transl Immunology 2021; 10:e1332. [PMID: 34532040 PMCID: PMC8435365 DOI: 10.1002/cti2.1332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/20/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives To study the percentage, suppressive function and plasticity of Treg in giant cell arteritis (GCA), and the effects of glucocorticoids and tocilizumab. Methods Blood samples were obtained from 40 controls and 43 GCA patients at baseline and after treatment with glucocorticoids + IV tocilizumab (n = 20) or glucocorticoids (n = 23). Treg percentage and phenotype were assessed by flow cytometry. Suppressive function of Treg was assessed by measuring their ability to inhibit effector T‐cell (Teff) proliferation and polarisation into Th1 and Th17 cells. Results Treg (CD4+CD25highFoxP3+) frequency in total CD4+ T cells was decreased in active GCA patients when compared to controls (2.5% vs. 4.7%, P < 0.001) and increased after treatment with tocilizumab but worsened after treatment with glucocorticoids alone. Treg lacking exon 2 of FoxP3 were increased in GCA patients when compared to controls (23% vs. 10% of total Treg, P = 0.0096) and normalised after treatment with tocilizumab + glucocorticoids but not glucocorticoids alone. In GCA patients, Treg were unable to control Teff proliferation and induced ˜50% increase in the amount of IL‐17+ Teff, which was improved after in vitro blockade of the IL‐6 pathway by tocilizumab. Conclusion This study reports quantitative and functional disruptions in the regulatory immune response of GCA patients and demonstrates that, unlike glucocorticoids, tocilizumab improves Treg immune response.
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Affiliation(s)
- Maxime Samson
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Marion Ciudad
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Claire Gerard
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Thibault Ghesquière
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Malika Trad
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Marc Corbera-Bellalta
- Vasculitis Research Unit Department of Autoimmune Diseases Hospital Clinic University of Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) CRB-CELLEX Barcelona Spain
| | - Coraline Genet
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Sethi Ouandji
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Claudie Cladière
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Marine Thebault
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Kim Heang Ly
- Department of Internal Medicine CHU de Limoges Limoges France
| | - Eric Liozon
- Department of Internal Medicine CHU de Limoges Limoges France
| | - François Maurier
- Department of Internal Medicine HP-Metz Site Belle Isle Metz France
| | - Boris Bienvenu
- Department of Internal Medicine Hôpital Saint-Joseph Marseille France
| | - Benjamin Terrier
- Department of Internal Medicine National Referral Center for Systemic and Rare Autoimmune Diseases Hôpital Cochin APHP Paris France
| | - Loïc Guillevin
- Department of Internal Medicine National Referral Center for Systemic and Rare Autoimmune Diseases Hôpital Cochin APHP Paris France
| | - Pierre Charles
- Department of Internal Medicine Institut Mutualiste Montsouris Paris France
| | - Valérie Quipourt
- Department of Geriatric Internal Medicine Dijon University Hospital Dijon France
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases Dijon University Hospital Dijon France.,INSERM CIC 1432 Clinical Epidemiology Unit Dijon France
| | | | | | - Georges Tarris
- Department of Pathology Dijon University Hospital Dijon France
| | - Laurent Martin
- Department of Pathology Dijon University Hospital Dijon France
| | - Philippe Saas
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France.,CIC-1431 INSERM Besançon University Hospital EFS Besançon France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Maria Cinta Cid
- Vasculitis Research Unit Department of Autoimmune Diseases Hospital Clinic University of Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) CRB-CELLEX Barcelona Spain
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
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Aussedat M, Lobbes H, Samson M, Euvrard R, Lega JC, Mainbourg S. Epidemiology of major relapse in giant cell arteritis: A study-level meta-analysis. Autoimmun Rev 2021; 21:102930. [PMID: 34481940 DOI: 10.1016/j.autrev.2021.102930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The relapse rate of giant cell arteritis (GCA) is around 48%. Major relapse of GCA is defined by the European League Against Rheumatism as severe ischemic or aortic (stenosis, aneurysm, or aortic dissection) disease of GCA. The objective of the present study was to determine the prevalence and incidence, as well as the spectrum of major relapse in GCA using published data. METHODS The MEDLINE and Cochrane databases were searched up to March 2020. Studies that included patients with newly diagnosed or relapsed GCA receiving glucocorticoids (GC) alone and/or GC-sparing therapy, detailing the number of relapsing patients and the characteristics of relapses were included. The prevalence and incidence of major relapse were pooled using a random-effects model. RESULTS Twenty-six studies (including eight randomised controlled trials) involving 2754 patients with GCA were included. The prevalence and incidence of major relapse in this population was 3.3% (95%CI [1.7;5.6]; I2 = 86%) and 14.5/100 patient-years (95%CI [5.2;27.2]; I2 = 90%). The clinical manifestations were jaw claudication (44.3%), ophthalmological involvement (32.7%), peripheral limb ischemia (12.5%), aortic (7.7%), and neurological involvements (4.8%). In the meta-regression analysis, the duration of follow-up was negatively associated with the incidence of major relapse (Beta = -0.015, 95%CI [-0.026; -0.0042]; p = 0.0063). The incidence of major relapse was significantly higher in prospective studies (55.2/100 person-years, 95%CI [15.3;114.3] than in retrospective studies (4.1/100 patient-years, 95%CI[1.1;8.4]; pinteraction = 0.000.2). CONCLUSION This study found that there was heterogeneity among studies, and this is partially related to study design. Jaw claudication was frequent and increases the prevalence and incidence of relapses major.
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Affiliation(s)
- Marie Aussedat
- Institut du Vieillissement I-Vie, Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France
| | - Hervé Lobbes
- Service de médecine interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, F-63100 Clermont-Ferrand, France
| | - Maxime Samson
- Service de médecine interne et d'immunologie clinique, CHU Dijon Bourgogne, Hôpital François Mitterrand, F-21000 Dijon, France
| | - Romain Euvrard
- Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, F-69495 Pierre-Bénite, France
| | - Jean-Christophe Lega
- Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, F-69495 Pierre-Bénite, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, F-69622 Villeurbanne, France; Lyon immunopathology FEderation (LIFE), Hospices Civils de Lyon, F-69003 Lyon, France
| | - Sabine Mainbourg
- Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, F-69495 Pierre-Bénite, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, F-69622 Villeurbanne, France; Lyon immunopathology FEderation (LIFE), Hospices Civils de Lyon, F-69003 Lyon, France.
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Greigert H, Zeller M, Putot A, Steinmetz E, Terriat B, Maza M, Falvo N, Muller G, Arnould L, Creuzot-Garcher C, Ramon A, Martin L, Tarris G, Ponnelle T, Audia S, Bonnotte B, Cottin Y, Samson M. Myocardial infarction during giant cell arteritis: A cohort study. Eur J Intern Med 2021; 89:30-38. [PMID: 33610415 DOI: 10.1016/j.ejim.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cardiovascular risk is increased in giant cell arteritis (GCA). We aimed to characterize myocardial infarction (MI) in a GCA cohort, and to compare the GCA and non-GCA population affected by MI. METHODS In patients with a biopsy-proven diagnosis of GCA between 1 January 2001 and 31 December 2016 in Côte D'Or (France), we identified patients with MI by crossing data from the territorial myocardial infarction registry (Observatoire des Infarctus de Côte d'Or) database. Five controls (non-GCA + MI) were paired with one case (GCA + MI) after matching for age, sex, cardiovascular risk factors and prior cardiovascular disease. MI were characterized as type 1 MI (T1MI), resulting from thrombus formation due to atherothrombotic disease, or type 2 MI (T2MI), due to a myocardial supply/demand mismatch. GCA-related MI was defined as MI occurring within 3 months of a GCA flare (before or after). RESULTS Among 251 biopsy-proven GCA patients, 13 MI cases were identified and paired with 65 controls. MI was GCA-related in 6/13 cases, accounting for 2.4% (6/251) of our cohort. T2MI was more frequently GCA-related than GCA-unrelated (80% vs. 16.7%, p = 0.080), and GCA diagnosis was the only identified triggering factor in 75% of GCA-related T2MI. GCA-unrelated MI were more frequently T1MI and occurred in patients who had received a higher cumulative dose of prednisone (p = 0.032). GCA was not associated with poorer one-year survival. CONCLUSIONS GCA-related MI are mainly T2MI probably caused by systemic inflammation rather than coronaritis. GCA-unrelated MI are predominantly T1MI associated with atherothrombotic coronary artery disease.
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Affiliation(s)
- Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Department of Vascular Medicine, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | | | - Alain Putot
- PEC2, EA 7460 Dijon, France; Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Eric Steinmetz
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Béatrice Terriat
- Department of Vascular Medicine, Dijon University Hospital, Dijon, France
| | | | - Nicolas Falvo
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Géraldine Muller
- Department of Internal Medicine and Systemic Diseases, Dijon University Hospital, Dijon, France
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, Dijon, France
| | | | - André Ramon
- Department of Rheumatology, Dijon University Hospital, Dijon, France
| | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Georges Tarris
- Department of Pathology, Dijon University Hospital, Dijon, France
| | | | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | - Yves Cottin
- Cardiology Department, Dijon University Hospital, Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France.
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12
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Zongfei J, Lijuan Z, Ying S, Dongmei L, Sifan W, Xiufang K, Lingying M, Yun L, Lili M, Huiyong C, Lindi J. Improved clinical outcomes of tocilizumab versus cyclophosphamide for IgG4-related disease: insights from a prospective IgG4-related disease registry. Ther Adv Chronic Dis 2021; 12:20406223211028776. [PMID: 34262681 PMCID: PMC8252355 DOI: 10.1177/20406223211028776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/10/2021] [Indexed: 01/13/2023] Open
Abstract
Objective To compare the clinical outcomes of patients with active immunoglobulin G (IgG) 4 related disease (IgG4-RD) receiving tocilizumab versus those receiving cyclophosphamide (CYC). Methods This IgG4-RD registry study was a prospective cohort study conducted among patients with active IgG4-RD hospitalized at Zhongshan Hospital, Fudan University. Patients who were treated with tocilizumab or CYC along with glucocorticoids (GCs) were enrolled. All participants were followed up at the hospital clinic at 3 and 6 months after discharge. Primary clinical outcomes were measured via the IgG4-RD responder index (RI), complete response (CR), and partial response (PR), as well as side effects. Results From January 2015 to June 2020, 29 patients enrolled. Fourteen and 15 patients were treated with tocilizumab and CYC, respectively. At the 6-month follow-up, disease activity parameters including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), IgG4, and IgG4-RD RI, decreased significantly in both groups. At 6 months, tocilizumab demonstrated its superiority, with 50% of patients achieving CR in the Tocilizumab group versus 20% in the CYC group. However, no statistical significance was identified (p = 0.128). The GC dosage at 6 months was significantly lower in the tocilizumab group than in the CYC group [10 (9.4-15) mg/d versus 15 (15-15) mg/d, p = 0.025]. In the CYC group, two patients experienced lumbar vertebral compression fractures related to GCs. Other patients in both groups showed mild adverse effects. Conclusions Tocilizumab could be a better steroid-sparing agent, with a comparable curative effect and tolerance, than CYC, in the treatment of IgG4-RD.
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Affiliation(s)
- Ji Zongfei
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China Center of Clinical Epidemiology and Evidence-Based Medicine, Fudan University, Shanghai, China
| | - Zhang Lijuan
- Department of Rheumatology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, Fujian Province, China
| | - Sun Ying
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China Center of Clinical Epidemiology and Evidence-Based Medicine, Fudan University, Shanghai, China
| | - Liu Dongmei
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China Center of Clinical Epidemiology and Evidence-Based Medicine, Fudan University, Shanghai, China
| | - Wu Sifan
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China Center of Clinical Epidemiology and Evidence-Based Medicine, Fudan University, Shanghai, China
| | - Kong Xiufang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China Center of Clinical Epidemiology and Evidence-Based Medicine, Fudan University, Shanghai, China
| | - Ma Lingying
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China Center of Clinical Epidemiology and Evidence-Based Medicine, Fudan University, Shanghai, China
| | - Liu Yun
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China Center of Clinical Epidemiology and Evidence-Based Medicine, Fudan University, Shanghai, China
| | - Ma Lili
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China Center of Clinical Epidemiology and Evidence-Based Medicine, Fudan University, Shanghai, China
| | - Chen Huiyong
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China Center of Clinical Epidemiology and Evidence-Based Medicine, Fudan University, Shanghai, China
| | - Jiang Lindi
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China Center of Clinical Epidemiology and Evidence-Based Medicine, Fudan University, Shanghai, China
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Gérard AL, Simon-Tillaux N, Yordanov Y, Cacoub P, Tubach F, Saadoun D, Dechartres A. Efficacy and safety of steroid-sparing treatments in giant cell arteritis according to the glucocorticoids tapering regimen: A systematic review and meta-analysis. Eur J Intern Med 2021; 88:96-103. [PMID: 33879385 DOI: 10.1016/j.ejim.2021.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of adjuvant therapies in newly diagnosed or relapsing giant cell arteritis (GCA) in terms of relapse rate at week 52 (primary outcome) and to assess the impact of GC tapering regimen on adjuvant effectiveness. METHODS For this systematic review and meta-analysis, we searched PubMed, EMBASE, CENTRAL, trial registries, from inception to November 2020. We included all randomized controlled trials (RCTs) and controlled prospective studies evaluating adjuvant treatments in GCA, without date or language restriction. Two reviewers independently selected studies, extracted data and assessed risk of bias. Quality of evidence was summarised with GRADE. RESULTS Of the 680 records identified, 16 studies were included (1,068 participants) evaluating various adjuvant therapies compared to GC only. No study compared adjuvants with each other. Risk of bias was high in 5/7 trials evaluating our primary outcome. Risk of relapse at week 52 was reduced for only the anti-IL6 and IL6-receptor drug class versus the control (RR=0.45, 95%CI 0.30-0.66, I2=38%), particularly tocilizumab (RR=0.38, 95%CI 0.23-0.63, I2=42%) with a moderate quality of evidence. We found no significant interaction according to GC tapering regimen. Our meta-analysis did not show a significant benefit for methotrexate. Except for dapsone, ciclosporine and hydroxychloroquine, other adjuvants did not seem to show increased risk of adverse events. CONCLUSIONS Tocilizumab seems to reduce the relapse rate in GCA at week 52 but the quality of evidence was moderate. No other molecule has shown efficacy. No significant interaction on relapse rate by GC tapering regimen was found. STUDY REGISTRATION PROSPERO CRD42020172011.
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Affiliation(s)
- Anne-Laure Gérard
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - Noémie Simon-Tillaux
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - Youri Yordanov
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP, Hôpital Saint-Antoine, Service d'Accueil des Urgences, Paris, France
| | - Patrice Cacoub
- Sorbonne Université, INSERM U959, Immunopathology, Immunotherapies of autoimmunes and inflammatory diseases, RHU I2B, Labex Transimunom, AP-HP, Hôpital Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France, Centre national de référence Maladies Autoimmunes systémiques rares, Centre national de référence Maladies Auto-inflammatoires et Amylose, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - David Saadoun
- Sorbonne Université, INSERM U959, Immunopathology, Immunotherapies of autoimmunes and inflammatory diseases, RHU I2B, Labex Transimunom, AP-HP, Hôpital Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France, Centre national de référence Maladies Autoimmunes systémiques rares, Centre national de référence Maladies Auto-inflammatoires et Amylose, France.
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France.
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Khanna RK, Hage R, Lecler A, Sene T, Vignal-Clermont C, Clavel-Refregiers G. Giant cell arteritis with ocular involvement successfully treated with tocilizumab and very short-course glucocorticoids: A case report. J Fr Ophtalmol 2021; 44:481-484. [PMID: 33712335 DOI: 10.1016/j.jfo.2020.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the case of a patient with arteritic anterior ischemic optic neuropathy (AAION) with a history of glucocorticoids (GC) hypersensitivity treated with monthly intravenous tocilizumab (IV TCZ) and short course of GC. CASE REPORT A 71-year-old Caucasian patient presented with AAION related to giant cell arteritis (GCA) confirmed by temporal artery biopsy. Past medical history was significant for GC hypersensitivity proven by allergy evaluation and the patient was managed with IV TCZ and very short-course GC. CONCLUSION TCZ therapy with very short-course GC could be effective in GCA with ophthalmic involvement as a first-line strategy. Clinical trials are needed for thorough evaluation of the efficiency of TCZ as a first-line treatment to induce and maintain remission in patients with GCA and ocular involvement.
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Affiliation(s)
- R K Khanna
- Department of ophthalmology, Fondation Adolphe-de-Rothschild hospital, 29, rue Manin, 75019 Paris, France.
| | - R Hage
- Department of ophthalmology, Fondation Adolphe-de-Rothschild hospital, 29, rue Manin, 75019 Paris, France
| | - A Lecler
- Department of neuroradiology, Fondation Adolphe-de-Rothschild hospital, Paris, France
| | - T Sene
- Department of internal medicine, Fondation Adolphe-de-Rothschild hospital, Paris, France
| | - C Vignal-Clermont
- Department of ophthalmology, Fondation Adolphe-de-Rothschild hospital, 29, rue Manin, 75019 Paris, France
| | - G Clavel-Refregiers
- Department of internal medicine, Fondation Adolphe-de-Rothschild hospital, Paris, France
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Pharmacological mechanism of immunomodulatory agents for the treatment of severe cases of COVID-19 infection. Inflamm Res 2021; 70:389-405. [PMID: 33608746 PMCID: PMC7894237 DOI: 10.1007/s00011-021-01445-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) is a world-wide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To date, treatment of severe COVID-19 is far from clear. Therefore, it is urgent to develop an effective option for the treatment of patients with COVID-19. Most patients with severe COVID-19 exhibit markedly increased serum levels of pro-inflammatory cytokines, including interferon (IFN)-α, IFN-γ, and interleukin (IL)-1β. Immunotherapeutic strategies have an important role in the suppression of cytokine storm and respiratory failure in patients with COVID-19. METHODS A systematic search in the literature was performed in PubMed, Scopus, Embase, Cochrane Library, Web of Science, as well as Google Scholar preprint database using all available MeSH terms for Coronavirus, SARS-CoV-2, anti-rheumatoid agents, COVID-19, cytokine storm, immunotherapeutic drugs, IFN, interleukin, JAK/STAT inhibitors, MCP, MIP, TNF. RESULTS Here, we first review common complications of COVID-19 patients, particularly neurological symptoms. We next explain host immune responses against COVID-19 particles. Finally, we summarize the existing experimental and clinical immunotherapeutic strategies, particularly anti-rheumatoid agents and also plasma (with a high level of gamma globulin) therapy for severe COVID-19 patients. We discuss both their therapeutic effects and side effects that should be taken into consideration for their clinical application. CONCLUSION It is suggested that immunosuppressants, such as anti-rheumatoid drugs, could be considered as a potential approach for the treatment of cytokine storm in severe cases of COVID-19. One possible limitation of immunosuppressant therapy is their inhibitory effects on host anti-viral immune response. So, the appropriate timing of administration should be carefully considered.
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A Multicentre, Randomised, Double-Blind, Placebo-Controlled, Parallel-Group Study to Evaluate the Efficacy and Safety of Sirukumab in the Treatment of Giant Cell Arteritis. Rheumatol Ther 2020; 7:793-810. [PMID: 32844378 PMCID: PMC7695797 DOI: 10.1007/s40744-020-00227-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION To evaluate the efficacy and safety of sirukumab in giant cell arteritis (GCA). METHODS In this multicentre, randomised, double-blind, placebo-controlled, two-part phase 3 trial (NCT02531633; Part A [52-week double-blind treatment]; Part B [104-week follow-up]), patients with GCA were randomised (3:3:2:2:2) to sirukumab 100 mg every 2 weeks plus 6-month or 3-month prednisone taper, sirukumab 50 mg every 4 weeks plus 6-month prednisone taper, or placebo every 2 weeks plus 6-month or 12-month prednisone taper. The primary endpoint was the proportion of patients in sustained remission at week 52. Secondary endpoints included disease flare and safety. The study was terminated early (October 2017; sponsor decision). RESULTS Of 161 patients randomised (sirukumab: n = 107; placebo: n = 54), 28 (17.4%) completed week 52 (median treatment duration: 24-30 weeks). In a revised intent-to-treat (ITT) subgroup (completed week 52 or discontinued before study termination [n = 55]); six patients (all receiving sirukumab) achieved the primary endpoint. In the ITT population (n = 161), the proportion of patients with flares (week 2-52) was lower with sirukumab (18.4-30.8%) than placebo (37.0-40.0%). The proportion of patients with flares (week 2-12) was highest with sirukumab 100 mg every 2 weeks plus 3-month prednisone taper (23.1%). In Part A, 94.4% of patients reported ≥ 1 treatment-emergent adverse event (TEAE); 19.3% reported serious TEAEs. The proportions of patients with TEAEs were generally similar across treatment arms. No deaths occurred. CONCLUSIONS Although data were limited due to early termination and shortened treatment duration, sirukumab treatment resulted in numerically lower proportions of patients with flare by week 52 versus placebo, with no unexpected safety findings. TRIAL REGISTRATION Clinicaltrials.gov: NCT02531633.
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Zongfei J, Rongyi C, Xiaomeng C, Lili M, Lingying M, Xiufang K, Xiaomin D, Zhuojun Z, Huiyong C, Ying S, Lindi J. In vitro IL-6/IL-6R Trans-Signaling in Fibroblasts Releases Cytokines That May Be Linked to the Pathogenesis of IgG4-Related Disease. Front Immunol 2020; 11:1272. [PMID: 32733444 PMCID: PMC7360847 DOI: 10.3389/fimmu.2020.01272] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022] Open
Abstract
Background: The remarkable mechanisms of storiform fibrosis and the formation of high levels of IgG4 with a pathogenic germinal center (GC) in the inflammatory tissue of IgG4-RD remains unknown and may be responsible for the unsatisfactory therapeutic effect on IgG4-related diseases when using conventional therapy. Objectives: To investigate the mechanisms of interleukin 6 (IL-6) inducing fibroblasts to produce cytokines for pathogenic GC formation in the development of IgG4-related disease (IgG4-RD). Methods: The clinical data and laboratory examinations of 56 patients with IgG4-RD were collected. IL-6 and IL-6R expression in the serum and tissues of patients with IgG4-RD and healthy controls were detected by ELISA, immunohistochemistry, and immunofluorescence. Human aorta adventitial fibroblasts (AAFs) were cultured and stimulated with IL-6/IL-6 receptor (IL-6R). The effect of IL-6/IL-6R on AAFs was determined by Luminex assays. Results: The serum IL-6 and IL-6R levels were elevated in active IgG4-RD patients and IL-6 was positively correlated with the disease activity (e.g., erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and IgG4-RD responder index). IL-6 and IL-6R expression in the tissue lesions of IgG4-related retroperitoneal fibrosis and IgG4-related sialadenitis patients were also significantly higher than that in the normal tissues. In addition, there is a relative abundance of myofibroblasts as well as IgG4+ plasma cells in the tissues of IgG4-related retroperitoneal fibrosis. α-SMA and B cell differentiation cytokines (i.e., B cell activating factor), and α-SMA and T follicular helper (Tfh) cell differentiation cytokines (e.g., IL-7, IL-12, and IL-23) were co-expressed in the local lesions. In vitro, IL-6/IL-6R significantly promoted the production of B cell activating factor, IL-7, IL-12, and IL-23 in AAFs in a dose-dependent manner. This effect was partially blocked by JAK1, JAK2, STAT3, and Akt inhibitors, respectively. Conclusions:In vitro IL-6/IL-6R trans-signaling in fibroblasts releases Tfh and B cell differentiation factors partially via the JAK2/STAT3, JAK1/STAT3, and JAK2/Akt pathways, which may be linked to the pathogenesis of IgG4-RD. This indicated that IL-6 and fibroblasts may be responsible for GC formation and fibrosis in the development of IgG4-RD. Blocking IL-6 with JAK1/2 inhibitors or inhibiting fibroblast proliferation might be beneficial for IgG4-RD treatment.
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Affiliation(s)
- Ji Zongfei
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-Based Medicine Center, Fudan University, Shanghai, China
| | - Chen Rongyi
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-Based Medicine Center, Fudan University, Shanghai, China
| | - Cui Xiaomeng
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-Based Medicine Center, Fudan University, Shanghai, China
| | - Ma Lili
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-Based Medicine Center, Fudan University, Shanghai, China
| | - Ma Lingying
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-Based Medicine Center, Fudan University, Shanghai, China
| | - Kong Xiufang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-Based Medicine Center, Fudan University, Shanghai, China
| | - Dai Xiaomin
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-Based Medicine Center, Fudan University, Shanghai, China
| | - Zhang Zhuojun
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-Based Medicine Center, Fudan University, Shanghai, China
| | - Chen Huiyong
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-Based Medicine Center, Fudan University, Shanghai, China
| | - Sun Ying
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-Based Medicine Center, Fudan University, Shanghai, China
| | - Jiang Lindi
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-Based Medicine Center, Fudan University, Shanghai, China
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Zhang S, Li L, Shen A, Chen Y, Qi Z. Rational Use of Tocilizumab in the Treatment of Novel Coronavirus Pneumonia. Clin Drug Investig 2020; 40:511-518. [PMID: 32337664 PMCID: PMC7183818 DOI: 10.1007/s40261-020-00917-3] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Since December 2019, a novel coronavirus pneumonia (COVID-19) has broken out in Wuhan, China and spread rapidly. Recent studies have found that ⁓ 15.7% of patients develop severe pneumonia, and cytokine storm is an important factor leading to rapid disease progression. Currently, there are no specific drugs for COVID-19 and the cytokine storm it causes. IL-6 is one of the key cytokines involved in infection-induced cytokine storm. Tocilizumab, which is the IL-6 receptor antagonist, has been approved by the US FDA for the treatment of cytokine release syndrome (CRS), is expected to treat cytokine storm caused by COVID-19 and is now in clinical trials. In this paper, we will elaborate the role of cytokine storm in COVID-19, the mechanism of tocilizumab on cytokine storm and the key points of pharmaceutical care based on the actual clinical application for COVID-19 in our hospital, the latest research reports, clinical trial progress of tocilizumab, drug instruction from the US FDA, and "Diagnosis and Treatment Plan of Novel Coronavirus Pneumonia (seventh trial edition)" in China, so as to provide reference for the treatment of COVID-19.
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Affiliation(s)
- Shengyu Zhang
- Department of Pharmacy, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Lei Li
- Infection Department, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Aizong Shen
- Department of Pharmacy, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Yongwu Chen
- Department of Pharmacy, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Zhigang Qi
- Department of Pharmacy, Wuxi People's Hospital Attached to Nanjing Medical University, Wuxi, 214023, Jiangsu, China.
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Michaud M, Catros F, Gaches F. Usefulness of serum amyloid a protein dosage for monitoring patients receiving tocilizumab. Eur J Intern Med 2020; 74:115-116. [PMID: 31926783 DOI: 10.1016/j.ejim.2019.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Martin Michaud
- Department of Internal Medicine, Joseph Ducuing Hospital, 15 rue Varsovie, Toulouse 31076, France.
| | - Florian Catros
- Department of Internal Medicine, Joseph Ducuing Hospital, 15 rue Varsovie, Toulouse 31076, France
| | - Francis Gaches
- Department of Internal Medicine, Joseph Ducuing Hospital, 15 rue Varsovie, Toulouse 31076, France
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Dammacco R, Alessio G, Giancipoli E, Leone P, Cirulli A, Resta L, Vacca A, Dammacco F. Giant Cell Arteritis: The Experience of Two Collaborative Referral Centers and an Overview of Disease Pathogenesis and Therapeutic Advancements. Clin Ophthalmol 2020; 14:775-793. [PMID: 32210531 PMCID: PMC7073434 DOI: 10.2147/opth.s243203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Giant cell arteritis (GCA), a chronic vasculitis of the large and medium-sized arteries, affects people >50 years of age. This study assessed the prevalence of visual manifestations and other clinical features at presentation in an Italian cohort of GCA patients. Recent advances in the pathophysiology, diagnosis, and therapy of GCA are also reviewed. Methods This retrospective, single-center study conducted by the ophthalmology and internal medicine clinics of one university recruited 56 patients from 2005 to 2016 and followed them for 11-54 months. Results Ocular involvement was diagnosed in 19 patients (33.9%), with permanent vision loss in 19.6% (7.1% of the cohort with bilateral vision loss). Arteritic anterior and posterior ischemic optic neuropathy were diagnosed in 11 patients (57.9%) and 1 patient (5.3%), respectively, cotton wool spots in 3 patients (15.8%), central retinal artery occlusion in 2 patients (10.5%), and anterior segment ischemia and multifocal choroidal ischemia in 1 patient each (5.3%). Polymyalgia rheumatica was associated with GCA in 44.6% of the patients. The most common extra-ocular manifestation was constitutional symptoms (82.1% of the patients). Large-vessel involvement, including of the ascending aorta, aortic arch, and left axillary artery, was diagnosed by magnetic resonance or computed tomography (CT) angiography and 18FDG positron emission/CT. Glucocorticoids (GCs) remain the standard-of-care worldwide, but methotrexate, provided as a steroid-sparing drug in 41% of the patients, resulted in earlier tapering, a lower cumulative dose of GCs, and a lower rate of relapse. Among the combinations of GCs and immunosuppressive drugs proposed to treat GCA, only tocilizumab has effectively induced and maintained disease remission. Conclusion According to our data and literature reports: a) GCA is a systemic disease; b) its diagnosis is expedited by the adjunct use of imaging techniques; c) insights into the pathogenesis of GCA may allow an improved, differentiated therapeutic approach.
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Affiliation(s)
- Rosanna Dammacco
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Giovanni Alessio
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Ermete Giancipoli
- Department of Biomedical Sciences, Ophthalmology Unit, University of Sassari, Sassari, Italy
| | - Patrizia Leone
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Anna Cirulli
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Leonardo Resta
- Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
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Enfrein A, Espitia O, Bonnard G, Agard C. Aortite de l’artérite à cellules géantes : diagnostic, pronostic et traitement. Presse Med 2019; 48:956-967. [DOI: 10.1016/j.lpm.2019.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/10/2019] [Accepted: 04/15/2019] [Indexed: 01/16/2023] Open
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Different patterns and specific outcomes of large-vessel involvements in giant cell arteritis. J Autoimmun 2019; 103:102283. [DOI: 10.1016/j.jaut.2019.05.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 02/08/2023]
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Abstract
Glucocorticoids (GC) remain the gold standard of the treatment of giant cell arteritis provided objectives of GC-tapering are accurately followed: 15 to 20mg/day at 3 months, 10mg/day at 6 months, 5mg/day at 9-12 months and withdrawal between 12 and 18 months. In case of corticodependance at ≥7.5 mg/day of prednisone or intolerance to GC, a GCsparing therapy has to be introduced, mainly methotrexate or tocilizumab. Individual characteristics of each patient, data about the efficacy of the treatment, its cost and how easy the follow-up under this treatment is are important factors to consider for choosing the right GC-sparing therapy. For all these reasons, except particular situations, we prefer using methotrexate before tocilizumab. Prevention of cardiovascular events is an important aspect of the treatment of GCA. We recommend using aspirin (75-100mg/day) during the first month of treatment or longer in case of occurrence of an ischemic complication. Each patient treated for GCA should receive a prevention of osteoporosis with respect of usual recommendations.
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Nannini C, Niccoli L, Sestini S, Laghai I, Coppola A, Cantini F. Remission maintenance after tocilizumab dose-tapering and interruption in
patients with giant cell arteritis: an open-label, 18-month, prospective,
pilot study. Ann Rheum Dis 2019; 78:1444-1446. [DOI: 10.1136/annrheumdis-2019-215585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/18/2019] [Accepted: 06/08/2019] [Indexed: 11/04/2022]
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Samson M, Bonnotte B. Analysis of IL-6 measurement in patients with GCA treated with tocilizumab should consider concomitant treatment with prednisone. Ann Rheum Dis 2019; 79:e102. [DOI: 10.1136/annrheumdis-2019-215697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 11/04/2022]
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