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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
Racial and Ethnic Disparities in Severe Ischemic Manifestations and Tocilizumab Use Among Patients With Giant Cell
Daniel M Markowitz1, Jose S Pulido, Jirat Nimworaphan
1Drexel University College of Medicine (DMM), Philadelphia, Pennsylvania; William H. Annesley Jr. EyeBrain Center (DMM, JN, RCS), Vicky and Jack Farber Neuroscience Institute, Thomas Jefferson University, Partnered with Wills Eye Hospital, Philadelphia, Pennsylvania; Retina Service (JSP), Wills Eye Hospital, Philadelphia, Pennsylvania; Faculty of Medicine Vajira Hospital (JN), Department of Ophthalmology, Navamindradhiraj University, Bangkok, Thailand; and Department of Ophthalmology (JJC), Mayo Clinic, Rochester, Minnesota.
Background:
Giant cell arteritis (GCA) has traditionally been recognized as more common in White populations, but there is limited understanding of its epidemiology and severe ischemic manifestations in other racial and ethnic groups. This study investigated racial and ethnic differences in GCA ischemic manifestations and tocilizumab use.
Methods:
We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network. Age- and sex-matched cohorts of non-Hispanic White (hereafter referred to as White), non-Hispanic Black or African American (Black), non-Hispanic Asian (Asian), and Hispanic or Latino (Hispanic) patients diagnosed with GCA were analyzed for differences in severe clinical manifestations within 1 month of GCA diagnosis (ischemic optic neuropathy, blindness/low vision, central retinal artery occlusion, stroke, aortic aneurysm and dissection, acute myocardial infarction) and tocilizumab use within 1 year.
Results:
Compared with White patients, Black patients had lower odds of ischemic optic neuropathy (odds ratio [OR]: 0.46, 95% confidence interval [CI]: 0.33-0.65), higher stroke risk (OR: 1.68, 95% CI: 1.16-2.43), and were less likely to receive tocilizumab (OR: 0.44, 95% CI: 0.33-0.59). Hispanic patients had lower odds of ischemic optic neuropathy (OR: 0.61, 95% CI: 0.37-0.98) and receiving tocilizumab (OR: 0.51, 95% CI: 0.34-0.74) compared with White patients. Additionally, compared with White patients, Asian patients were less likely to be diagnosed with blindness/low vision (OR: 0.45, 95% CI: 0.27-0.76), had similar odds of ischemic optic neuropathy, and had no significant differences in tocilizumab use.
Conclusions:
There may be significant differences in severe ischemic manifestations of GCA among non-White patients compared with White patients. There also appear to be differences in treatment with tocilizumab between Black and White patients and between Hispanic and White patients, but not between Asian and White patients.
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