1
|
Calderón-Goercke M, Castañeda S, Aldasoro V, Villa I, Prieto-Peña D, Atienza-Mateo B, Patiño E, Moriano C, Romero-Yuste S, Narváez J, Gómez-Arango C, Pérez-Pampín E, Melero R, Becerra-Fernández E, Revenga M, Álvarez-Rivas N, Galisteo C, Sivera F, Olivé-Marqués A, Álvarez Del Buergo M, Marena-Rojas L, Fernández-López C, Navarro F, Raya E, Galindez-Agirregoikoa E, Arca B, Solans-Laqué R, Conesa A, Hidalgo C, Vázquez C, Román-Ivorra JA, Loricera J, Lluch P, Manrique-Arija S, Vela P, De Miguel E, Torres-Martín C, Nieto JC, Ordas-Calvo C, Salgado-Pérez E, Luna-Gomez C, Toyos-Sáenz de Miera FJ, Fernández-Llanio N, García A, Larena C, González-Vela C, Corrales A, Varela-García M, Aurrecoechea E, Dos Santos R, García-Manzanares Á, Ortego N, Fernández S, Ortiz-Sanjuán F, Corteguera M, Hernández JL, González-Gay MÁ, Blanco R. Tocilizumab in giant cell arteritis: differences between the GiACTA trial and a multicentre series of patients from the clinical practice. Clin Exp Rheumatol 2020; 38 Suppl 124:112-119. [PMID: 32441643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES A potential point of concern among clinicians is whether results derived from the clinical trials can be reasonably applied or generalised to a definable group of patients seen in real world. It can be the case of the GiACTA study that is a phase III randomised controlled trial of tocilizumab (TCZ) in giant cell arteritis (GCA). To address this question, we compared the clinical features and the responses to TCZ from the GiACTA trial patients with those from a series of GCA seen in the daily clinical practice. METHODS Comparative study of clinical features between patients from the GiACTA trial (overall n=251) and those from a multicentre series of real-world GCA patients undergoing TCZ therapy (n=134). The diagnosis of GCA in the GiACTA trial was established by the ACR modified criteria whereas in the series of real-world patients it was made by using the ACR criteria, a positive biopsy of temporal artery or the presence of imaging techniques consistent with large-vessel vasculitis in individuals who presented cranial symptoms of GCA. GiACTA trial patients received subcutaneous TCZ (162 mg every 1 or 2 weeks) whereas those from the clinical practice series were treated using standard IV dose (8 mg/kg/month) or subcutaneous (162 mg/week). RESULTS Real-life patients undergoing TCZ were older with longer disease duration and higher values of ESR and had received conventional immunosuppressive therapy (mainly methotrexate) more commonly than those included in the GiACTA trial. Despite clinical differences, TCZ was equally effective in both GiACTA trial and clinical practice patients. However, serious infections were more commonly observed in GCA patients recruited from the clinical practice. CONCLUSIONS Despite clinical differences with patients recruited in clinical trials, data from real-life patients confirm the efficacy of TCZ in GCA.
Collapse
Affiliation(s)
- Mónica Calderón-Goercke
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma (UAM), Madrid, Spain
| | - Vicente Aldasoro
- Department of Rheumatology, Complejo Hospitalario de Navarra, Spain
| | - Ignacio Villa
- Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Cantabria, Spain
| | - Diana Prieto-Peña
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Belén Atienza-Mateo
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Esther Patiño
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma (UAM), Madrid, Spain
| | - Clara Moriano
- Department of Rheumatology, Complejo Asistencial Universitario de León, Spain
| | - Susana Romero-Yuste
- Department of Rheumatology, Complejo Hospitalario Universitario Pontevedra, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain
| | | | - Eva Pérez-Pampín
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Rafael Melero
- Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Spain
| | | | | | | | - Carles Galisteo
- Department of Rheumatology, Hospital Parc Taulí, Barcelona, Spain
| | - Francisca Sivera
- Department of Rheumatology, Hospital Universitario de Elda, Alicante, Spain
| | | | | | - Luisa Marena-Rojas
- Department of Rheumatology, Hospital La Mancha Centro, Alcázar de San Juan, Spain
| | | | - Francisco Navarro
- Department of Rheumatology, Hospital General Universitario de Elche, Alicante, Spain
| | - Enrique Raya
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | | | - Beatriz Arca
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | - Roser Solans-Laqué
- Department of Internal Medicine, Hospital Valle de Hebrón, Barcelona, Spain
| | - Arantxa Conesa
- Department of Rheumatology, Hospital General Universitario de Castellón, Spain
| | - Cristina Hidalgo
- Department of Rheumatology, Complejo Asistencial Universitario de Salamanca, Spain
| | - Carlos Vázquez
- Department of Rheumatology, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Javier Loricera
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Pau Lluch
- Department of Rheumatology, Hospital Mateu Orfila, Menorca, Spain
| | | | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Spain
| | | | | | - Juan Carlos Nieto
- Department of Rheumatology, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Eva Salgado-Pérez
- Department of Rheumatology, Complejo Hospitalario Universitario de Ourense, Spain
| | - Cristina Luna-Gomez
- Department of Rheumatology, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | | | | | - Antonio García
- Department of Rheumatology, Hospital Virgen de las Nieves, Granada, Spain
| | - Carmen Larena
- Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain
| | - Carmen González-Vela
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Alfonso Corrales
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - María Varela-García
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma (UAM), Madrid, Spain
| | - Elena Aurrecoechea
- Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Cantabria, Spain
| | - Raquel Dos Santos
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Norberto Ortego
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | - Sabela Fernández
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | | | | | - José L Hernández
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Miguel Á González-Gay
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
| | - Ricardo Blanco
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
| |
Collapse
|
2
|
Calderón-Goercke M, Loricera J, Aldasoro V, Castañeda S, Villa I, Humbría A, Moriano C, Romero-Yuste S, Narváez J, Gómez-Arango C, Pérez-Pampín E, Melero R, Becerra-Fernández E, Revenga M, Álvarez-Rivas N, Galisteo C, Sivera F, Olivé-Marqués A, Álvarez Del Buergo M, Marena-Rojas L, Fernández-López C, Navarro F, Raya E, Galindez-Agirregoikoa E, Arca B, Solans-Laqué R, Conesa A, Hidalgo C, Vázquez C, Román-Ivorra JA, Lluch P, Manrique-Arija S, Vela P, De Miguel E, Torres-Martín C, Nieto JC, Ordas-Calvo C, Salgado-Pérez E, Luna-Gomez C, Toyos-Sáenz de Miera FJ, Fernández-Llanio N, García A, Larena C, Palmou-Fontana N, Calvo-Río V, Prieto-Peña D, González-Vela C, Corrales A, Varela-García M, Aurrecoechea E, Dos Santos R, García-Manzanares Á, Ortego N, Fernández S, Ortiz-Sanjuán F, Corteguera M, Hernández JL, González-Gay MÁ, Blanco R. Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum 2019; 49:126-135. [PMID: 30655091 DOI: 10.1016/j.semarthrit.2019.01.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Tocilizumab (TCZ) has shown efficacy in clinical trials on giant cell arteritis (GCA). Real-world data are scarce. Our objective was to assess efficacy and safety of TCZ in unselected patients with GCA in clinical practice Methods: Observational, open-label multicenter study from 40 national referral centers of GCA patients treated with TCZ due to inefficacy or adverse events of previous therapy. Outcomes variables were improvement of clinical features, acute phase reactants, glucocorticoid-sparing effect, prolonged remission and relapses. A comparative study was performed: (a) TCZ route (SC vs. IV); (b) GCA duration (≤6 vs. >6 months); (c) serious infections (with or without); (d) ≤15 vs. >15 mg/day at TCZ onset. RESULTS 134 patients; mean age, 73.0 ± 8.8 years. TCZ was started after a median [IQR] time from GCA diagnosis of 13.5 [5.0-33.5] months. Ninety-eight (73.1%) patients had received immunosuppressive agents. After 1 month of TCZ 93.9% experienced clinical improvement. Reduction of CRP from 1.7 [0.4-3.2] to 0.11 [0.05-0.5] mg/dL (p < 0.0001), ESR from 33 [14.5-61] to 6 [2-12] mm/1st hour (p < 0.0001) and decrease in patients with anemia from 16.4% to 3.8% (p < 0.0001) were observed. Regardless of administration route or disease duration, clinical improvement leading to remission at 6, 12, 18, 24 months was observed in 55.5%, 70.4%, 69.2% and 90% of patients. Most relevant adverse side-effect was serious infections (10.6/100 patients-year), associated with higher doses of prednisone during the first three months of therapy. CONCLUSION In clinical practice, TCZ yields a rapid and maintained improvement of refractory GCA. Serious infections appear to be higher than in clinical trials.
Collapse
Affiliation(s)
- Mónica Calderón-Goercke
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Javier Loricera
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Vicente Aldasoro
- Department of Rheumatology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Ignacio Villa
- Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Spain
| | - Alicia Humbría
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Clara Moriano
- Department of Rheumatology, Complejo Asistencial Universitario de León, León, Spain
| | - Susana Romero-Yuste
- Department of Rheumatology, Complejo Hospitalario Universitario Pontevedra, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain
| | | | - Eva Pérez-Pampín
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Rafael Melero
- Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | | | - Carles Galisteo
- Department of Rheumatology, Hospital Parc Taulí, Barcelona, Spain
| | - Francisca Sivera
- Department of Rheumatology, Hospital Universitario de Elda, Alicante, Spain
| | | | | | - Luisa Marena-Rojas
- Department of Rheumatology, Hospital La Mancha Centro, Alcázar de San Juan, Spain
| | | | - Francisco Navarro
- Department of Rheumatology, Hospital General Universitario de Elche, Alicante, Spain
| | - Enrique Raya
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | | | - Beatriz Arca
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | - Roser Solans-Laqué
- Department of Internal Medicine, Hospital Valle de Hebrón, Barcelona, Spain
| | - Arantxa Conesa
- Department of Rheumatology, Hospital General Universitario de Castellón, Spain
| | - Cristina Hidalgo
- Department of Rheumatology, Complejo Asistencial Universitario de Salamanca, Spain
| | - Carlos Vázquez
- Department of Rheumatology, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Pau Lluch
- Department of Rheumatology, Hospital Mateu Orfila, Menorca, Spain
| | | | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - Juan Carlos Nieto
- Department of Rheumatology, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Eva Salgado-Pérez
- Department of Rheumatology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Cristina Luna-Gomez
- Department of Rheumatology, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | | | | | - Antonio García
- Department of Rheumatology, Hospital Virgen de las Nieves, Granada, Spain
| | - Carmen Larena
- Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain
| | - Natalia Palmou-Fontana
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Vanesa Calvo-Río
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Diana Prieto-Peña
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Carmen González-Vela
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Alfonso Corrales
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - María Varela-García
- Department of Rheumatology, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Raquel Dos Santos
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Norberto Ortego
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | - Sabela Fernández
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | | | | | - José L Hernández
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Miguel Á González-Gay
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
| | - Ricardo Blanco
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
| |
Collapse
|