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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
Delays in Tocilizumab Therapy for Patients With Giant Cell Arteritis in the United States
Dominique Feterman Jimenez1, Jenna L Thomason1, Jean W Liew2
1D. Feterman Jimenez, MD, J.L. Thomason, MD, G. Hughes, MD, A.M. Bays, MD, MPH&TM, Department of Medicine, Division of Rheumatology, University of Washington, Seattle, Washington.
Objective:
Despite the high risk for permanent vision loss in elderly individuals with giant cell arteritis (GCA), initiation of subcutaneous tocilizumab (TCZ) is often delayed. We used chart review for GCA patients prescribed subcutaneous TCZ to investigate delays in drug initiation.
Methods:
We included 82 patients with GCA at the University of Washington prescribed subcutaneous TCZ between 2017 and 2024. Time from medication request to medication approval/start and cost of TCZ were compared by insurance payor using 1-way ANOVA. Use of copay assistance, prior authorization requirement, drug manufacturer/foundation medication coverage, and switches to intravenous (IV) TCZ were compared by insurance using Pearson chi-square or Fisher exact tests.
Results:
For all patients with GCA, the mean time between request and first dose was 43 days; the mean time between request and insurance approval was 17 days, and the mean time between medication approval and medication start was 30 days. Patients with Medicare or Medicare Advantage paid significantly more out-of-pocket for the first month of TCZ ($1399 vs $823, P < 0.01) and had significantly higher rates of copay assistance (P < 0.01) and full coverage of medication by the drug manufacturer or foundation (P = 0.04).
Conclusion:
Patients with GCA experienced significant delays in starting TCZ therapy. In addition, patients on Medicare or Medicare Advantage plans had significantly higher out-of-pocket costs compared to other patients. These delays and costs are excessive for a vulnerable population with a potentially disabling disease. Further research is needed to investigate causes of delays, the high cost of medication, and effects on clinical outcomes.
Insights
Giant cell arteritis (GCA) patients face significant delays in starting subcutaneous tocilizumab (TCZ). Medicare patients experienced higher out-of-pocket costs, highlighting access barriers for this vulnerable population.
Area of Science:
- Rheumatology
- Ophthalmology
- Health Services Research
Background:
- Giant cell arteritis (GCA) poses a high risk of permanent vision loss in elderly patients.
- Prompt initiation of treatment, such as subcutaneous tocilizumab (TCZ), is crucial for preventing vision loss.
- Delays in TCZ initiation may negatively impact patient outcomes.
Purpose of the Study:
- To investigate delays in the initiation of subcutaneous TCZ for patients with GCA.
- To compare the time from medication request to initiation of TCZ therapy.
- To analyze the out-of-pocket costs associated with TCZ based on insurance payor.
Main Methods:
- Retrospective chart review of 82 GCA patients prescribed subcutaneous TCZ (2017-2024).
- Comparison of time from medication request to approval/start and TCZ costs by insurance payor using ANOVA.
- Analysis of copay assistance, prior authorization, and medication coverage using chi-square or Fisher exact tests.
Main Results:
- Mean time from request to first TCZ dose was 43 days (17 days for approval, 30 days from approval to start).
- Patients with Medicare/Medicare Advantage had significantly higher out-of-pocket costs ($1399 vs $823) for the first month of TCZ.
- Medicare patients showed higher rates of copay assistance and full medication coverage by manufacturers/foundations.
Conclusions:
- Significant delays in initiating subcutaneous TCZ therapy were observed in GCA patients.
- Patients with Medicare/Medicare Advantage plans incurred substantially higher out-of-pocket expenses.
- These delays and costs represent significant barriers for a vulnerable population and warrant further investigation into causes and clinical impact.
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