Objectives Giant cell arteritis (GCA) may lead to vision loss. To what extent tocilizumab (TCZ) is able to prevent vision loss is unknown. The aim was to analyze the occurrence of vision loss in a large GCA cohort treated with TCZ. Methods In this observational monocentric study, GCA patients treated with TCZ between the years 2010 and 2018 were studied. Demographic, clinical, and laboratory data were analyzed. Results A total of 186 patients were included (62% female); 109 (59%) fulfilled the American College of Rheumatology (ACR) criteria, in 123 (66%) patients, large vessel vasculitis was diagnosed by magnetic resonance-angiography (MRA). Cumulative duration of TCZ treatment was 224 years, median treatment duration was 11.1 (IQR 5.6–17.9) months. Glucocorticoids (GC) were tapered over a median of 5.8 (IQR 3.0–8.5) months. At baseline, visual symptoms were present in 70 (38%) and vision loss in 21 (11%) patients. Patients with vision loss at baseline were older (p = 0.032), had a lower C-reactive protein (p = 0.002), and showed a negative association with MRA of the aorta (p = 0.006). Two patients (1.1%) developed vision loss, both at the initiation of TCZ treatment. Conclusion Our data show a very low incidence of vision loss in TCZ-treated patient. The two cases of AION occurred at the initiation of therapy, they support the hypothesis that advanced, and established structural changes of arteries are key factors for this accident. Whether a shorter duration of concomitant GC treatment is risky regarding vision loss needs to be studied.

Background:Whether Tocilizumab (TCZ) may prevent vision loss in Giant Cell Arteritis (GCA) to the same extent as glucocorticoids remains a key and unanswered question. A patient cohort observed over up to 8 years addresses this issue.Objectives:To investigate the frequency of vision loss/visual impariment in a GCA cohort treated with TCZ.Methods:In this observational monocentric study, the courses of 192 patients with GCA treated with TCZ between 01.01.2011 and 31.12.2018 were analyzed. Data were extracted from medical records and collected in a Clinical Trial Unit (CTU) - based registry. Demographic, clinical and laboratory data were analyzed.Results:192 patients with GCA were treated with TCZ; 121 (63%) were female, 112 (58%) fulfilled 1990 American College of Rheumatology (ACR) criteria, all others had large vessel vasculitis based on magnetic resonance-angiography (MRA). The cumulative duration of TCZ treatment was 3467 months; the median treatment duration was 13.8 (8.5; 22.8) months. At baseline, visual impairment was present in 71 (37%) and vision loss in 21 (7.8%) patients. Visual loss was associated with higher age (74 (70; 82) vs. 70 (63; 76) years; p=0.029), lower C-reactive protein at baseline (14.0 (3.5; 42.0) vs. 54.5 (21.0; 101.0) mg/l; p<0.001), cranial symptoms (p<0.0001), jaw claudication (p=0.030) and negative MRA of the aorta (p=0.020). Over the observed time span only one patient taking part in a clinical trial developed vision loss. In total 4 (2%) patients with vision impairment showed deterioration and 61 (32%) improvement.Conclusion:Collectively, our data suggest that TCZ is able to prevent visual loss and may have a favorable effect on visual impairment.Disclosure of Interests:Jennifer Amsler: None declared, Iveta Kysela: None declared, Lisa Christ Consultant of: BMS, Christoph Tappeiner: None declared, Luca Seitz: None declared, Godehard Scholz: None declared, Florian Kollert Employee of: Novartis, Stephan Reichenbach: None declared, Peter Villiger Consultant of: MSD, Abbvie, Roche, Pfizer, Sanofi, Speakers bureau: Roche, MSD, Pfizer

Objectives: Giant cell arteritis (GCA) may lead to vision loss. To what extent tocilizumab (TCZ) is able to prevent vision loss is unknown. The aim was to analyze the occurrence of vision loss in a large GCA cohort treated with TCZ.Methods: In this observational monocentric study, GCA patients treated with TCZ between the years 2010 and 2018 were studied. Demographic, clinical and laboratory data were analyzed. Results: A total of 186 patients were included (62% female); 109 (59%) fulfilled the American College of Rheumatology (ACR) criteria, in 123 (66%) patients, large vessel vasculitis was diagnosed in magnetic resonance-angiography (MRA). Cumulative duration of TCZ treatment was 224 years, median treatment duration was 11.1 (IQR 5.6-17.9) months. Glucocorticoids (GC) were tapered over a median of 5.8 (IQR 3.0-8.5) months. At baseline, visual symptoms were present in 70 (38%) and vision loss in 21 (11%) patients. Patients with vision loss at baseline were older (p=0.032), had a lower C-reactive protein (p=0.002), more often cranial symptoms (p<0.001) or jaw claudication (p=0.031) and showed a negative association with MRA of the aorta (p=0.006). Two patients (1.1%) developed vision loss, both at initiation of TCZ treatment.Conclusion: Our data show a very low incidence of vision loss in TCZ-treated patient. The two cases of AION occurred at initiation of therapy, they support the hypothesis that advanced, and established structural changes of arteries are key factors for this accident. Whether shorter duration of concomitant GC treatment is risky regarding vision loss needs to be studied.