Fri0277 ischemic and Systemic Symptoms in Giant Cell Arteritis Patients, Response to Tocilizumab

Abstract

BackgroundIn Giant Cell Arteritis (GCA) two dominant cytokine clusters have been linked to disease activity, IL-6 – IL-17 axis (Th17) and IL-12 – IFN γ axis (Th1). The first one related to systemic symptoms and the second route responsible for ischemic symptoms. Tocilizumab (TCZ) performs its effect mainly by inhibiting Th17 axis and terminally Th1 route.ObjectivesOur aim was to evaluate the effect of TCZ on ischemic and systemic symptoms throughout the follow-up.MethodsRetrospective, multicenter study of 134 patients diagnosed of GCA on treatment with TCZ. We evaluate the efficacy of TCZ by improving ischemic (visual involvement, headache, jaw claudication) and systemic symptoms (fever, constitutional syndrome, polymyalgia rheumatica (PMR)).ResultsWe evaluated 134 patients (101 w/33 m) and its main symptoms at TCZ onset, TABLE. 73 (54.5%) patients presented PMR followed by headache in 70 (52.2%) cases, constitutional syndrome in 31 (23.1%) and visual involvement in 28 (20.9%) patients. After one month of treatment there was an important clinical improvement, persisting in 13,6% of patients PMR, 10.6% headache and 10.6% visual involvement. Throughout the follow-up, the improvement of ischemic symptoms was slower. At month 12, in 5.6% (4) of patients persisted with visual impairment, and 2.8% (2) patients presented headache and constitutional syndrome. However, the analytical improvement was statistically significant from the first month and sustained during follow-up.ConclusionAccording to the results of our study, we can conclude that in clinical practice, ischemic symptoms take longer to improve than systemic symptoms; being visual affectation the most frequent symptom after 12 months of follow-up.References[1] Soriano A, Muratore F, Pipitone N, Boiardi L, Cimino L, Salvarani C. Visual loss and other cranial ischaemic complications in giant cell arteritis. Nat Rev Rheumatol. 2017; 13:476-84.[2] Ciccia F, Rizzo A, Ferrante A, Guggino G, Croci S, Cavazza A, et al. New insights into the pathogenesis of giant cell arteritis. Autoimmun Rev. 2017; 16:675-83.[3] Calderón-Goercke M. Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum. 2019Jan5. pii: S0049-0172(18)30571-7. Doi: 10.1016/j.semarthrit.2019.01.003. [Epub ahead of print]Disclosure of InterestsMonica Calderón-Goercke: None declared, J. Loricera: None declared, D. Prieto-Peña: None declared, Vicente Aldasoro: None declared, Santos Castañeda Consultant for: Amgen, BMS, Pfizer, Lilly, MSD, Roche, Sanofi, UCB, Ignacio Villa-Blanco: None declared, Alicia Humbría: None declared, Clara Moriano: None declared, Susana Romero-Yuste: None declared, J. Narváez Consultant for: Bristol-Myers Squibb, Catalina Gomez-Arango: None declared, Eva Perez-Pampín: None declared, Rafael Melero: None declared, Elena Becerra-Fernández: None declared, Marcelino Revenga: None declared, Noelia Alvarez-Rivas: None declared, Carles Galisteo: None declared, Francisca Sivera: None declared, Alejandro Olive...

Actual possibilities and perspectives of biological drugs in treatment of systemic vasculitides. III. Biological drugs in giant cell arteritis

“…The results of several open uncontrolled observation studies of TCM in GCA at "real life" (usual clinical practice) are published, too [7,8,9,10,16,42,52,58]. On the basis of a considerable material (n = 307) the effects of TCM obtained by the controlled studies, were confirmed.…”

“…При пациентите, третирани с ТЦМ, втората предпоставка отпада -производството на ОФреактанти от хепатоцитите се стимулира от IL-6, а последният е блокиран функционално от ТЦМ. Остава да се разчита на прецизно снетите анамнеза и статус за наличие на клинични признаци: възобновено или с нова локализация главоболие, повишена температура, умора, нощно изпотяване, клаудикация на масетерите и/или езика, симптоматика на ревматична полимиалгия, палпаторна болезненост на a.temporalis и/или отслабване на пулсациите ѝ, хиперестезия на скалпа, намалени пулсации/RR на горни крайници, очна или симптоматика от страна на ЦНС [9,10,21,47,50,53,56]. Поради споменатите особености в темпа на промените на изобрази-телните находки чрез MRI, CT, PET/CT на тях не би могло да се разчита.…”

“…In the patients treated with TCM the second prerequisite drops off -the production of acute phase reactants from the hepatocytes is stimulated by IL-6, however, the last is blocked functionally by TCM. It remains to find a presence of an active disease: renewed headache, fever, fatigue, night-sweats, jaw and tongue claudication, symptomatics of polymyalgia rheumatica, tenderness of the temporal artery and/or its reduced pulsation, scalp tenderness, reduced pulses/blood pressure of the upper limbs, ophthalmic or CNS symptomatics, which all have to be differentiated from the elderly comorbidities [9,10,21,47,50,53,56]. In view of the above mentioned peculiarities in the changes pace of the imaging findings obtained by MRI, CT, PET/CT, one could not rely on them.…”