巨大細胞動脈炎に伴う大動脈炎における皮下対点滴トシリズマブ：196例の多施設共同研究

Aortitis associated with giant cell arteritis (GCA) is a severe manifestation, potentially leading to aneurysms and aortic dissection. Tocilizumab (TCZ) has demonstrated efficacy in the treatment of GCA, both intravenous (IV) or subcutaneously (SC) administered. However, pivotal studies did not specifically evaluate aortic involvement, and no comparison of IV versus SC TCZ has been performed in patients with GCA-related aortitis.

The objective of this study was to compare the effectiveness of TCZ according to the administration route in patients with GCA-associated aortitis under clinical practice conditions.

Multicenter observational study including 196 patients diagnosed with GCA-associated aortitis by imaging and treated with TCZ. Patients were grouped by administration route: IV or SC. GCA was diagnosed following the 1990 ACR criteria, temporal artery biopsy, and/or vascular imaging. Aortitis was identified using 18F-FDG PET/CT scan. Main outcomes included EULAR remission, clinical and imaging remission, absence of systemic inflammation, and glucocorticoid-sparing effect.

Of 196 patients (148 women; mean age 69.8 ± 9.4 years), 110 received IV TCZ and 86 SC TCZ. Baseline clinical characteristics and inflammatory markers were comparable between groups. The glucocorticoid-sparing effect was similar. At 24-month follow-up, EULAR-defined remission was significantly more frequent in the SC group (83.3% vs 80.6%; p<0.05). However, rates of imaging remission and absence of systemic inflammation were comparable between treatment arms.

In this real-world cohort of GCA-associated aortitis, SC TCZ showed slightly greater effectiveness than IV TCZ in achieving EULAR-defined remission while no significant differences were observed between both routes regarding imaging remission.