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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
Tocilizumab in Giant Cell Arteritis
Vincent J Mariano1, William H Frishman2
1From the Department of Medicine, Brown University/Rhode Island Hospital, Providence, RI.
Insights
Tocilizumab effectively treats giant cell arteritis (GCA), a serious vasculitis. This interleukin-6 receptor inhibitor offers a new, FDA-approved treatment option for patients with GCA, improving remission rates.
Area of Science:
- Rheumatology
- Immunology
- Vascular Medicine
Background:
- Giant cell arteritis (GCA) is a prevalent autoimmune vasculitis affecting medium and large arteries, primarily in older Caucasians.
- Current treatments, mainly high-dose corticosteroids, carry significant risks of morbidity and mortality.
- Interleukin-6 (IL-6) is implicated as a key cytokine in the pathogenesis of GCA.
Purpose of the Study:
- To evaluate the efficacy and safety of tocilizumab, an IL-6 receptor inhibitor, in treating giant cell arteritis.
- To assess tocilizumab's role as a potential alternative to corticosteroid therapy in GCA management.
Main Methods:
- Review of 15 case reports/series of patients treated with tocilizumab for refractory GCA or corticosteroid intolerance.
- Analysis of two randomized controlled trials (Villiger et al. phase II trial and GiACTA trial) assessing tocilizumab's efficacy and safety over one year.
Main Results:
- Most patients in case reports achieved symptom remission with tocilizumab, particularly those with refractory disease or steroid intolerance.
- Both randomized controlled trials demonstrated significantly higher rates of sustained remission in GCA patients treated with tocilizumab compared to placebo.
- Common adverse events included infections, neutropenia, and elevated lipids and liver enzymes, consistent with tocilizumab use in other inflammatory conditions.
Conclusions:
- Tocilizumab is the first FDA-approved agent for giant cell arteritis treatment.
- Tocilizumab demonstrates significant efficacy in achieving sustained remission for GCA patients.
- Tocilizumab offers a safer and effective alternative to prolonged high-dose corticosteroid therapy for GCA.
Abstract:
Giant cell arteritis is a granulomatous immune-mediated vasculitis of medium and large vessels. It most commonly affects white females over the age of 50 and is the most common primary vasculitis in the United States. Treatment of this disease has classically been with high-dose corticosteroids, but this therapy has been associated with severe morbidity and mortality. Tocilizumab, a humanized monoclonal antibody targeting the interleukin-6 receptor, has been used with great efficacy and safety in rheumatoid arthritis and systemic-onset juvenile idiopathic arthritis. As interleukin-6 has been shown to be a key cytokine in giant cell arteritis, the use of an inhibiting agent has been explored. In the 15 case reports/series that were reviewed, most patients were given tocilizumab due to refractory giant cell arteritis and/or intolerance to glucocorticoid therapy, and most experienced remission of symptoms. At this time, there are only 2 randomized control trials to evaluate the efficacy and safety of tocilizumab use in giant cell arteritis. The phase II trial by Villiger et al and the GiACTA trial both showed that tocilizumab greatly increased the rate of sustained remission in giant cell arteritis over the course of 1 year. The most common adverse events were similar to those seen with use in rheumatoid arthritis: infections, neutropenia, and increases in lipids and liver function test enzymes. Based on the results of numerous case studies and the 2 randomized control trials, tocilizumab is the first agent to be approved by the Food and Drug Administration for treatment of giant cell arteritis.
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