Giant cell arteritis: new concepts, treatments and the unmet need that remains

Coath, Fiona; Gillbert, Kate; Griffiths, Bridget; Hall, Frances; Kay, Lara; Lanyon, Peter; Luqmani, Raashid; McDermott, Michael; Mason, Justin C.; Mills, John A.; Mollan, Susan P; Morgan, Ann W; Mukhtyar, Chetan; Quick, Vanessa; Watts, Richard A.; Dasgupta, Bhaskar

doi:10.1093/rheumatology/key326

Cited by 20 publications

(17 citation statements)

References 8 publications

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“…The most common side effects include diarrhoea, raised blood pressure, elevated liver enzymes and leukopenia. There are case series Table 1 Current definitions of disease state, as adapted from Dasgupta et al 2018 [102] Terminology Definition…”

Section: Leflunomidementioning

confidence: 99%

A new era for giant cell arteritis

Lyons

Quick

Sinclair

et al. 2019

Eye

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The landscape of the investigation and management of giant cell arteritis (GCA) is advancing. In this review we will outline the recent advances by searching the current English literature for relevant articles using key words of giant cell arteritis, temporal arteritis, Horton's disease, investigation, and treatment. Delay in diagnosis, diagnostic uncertainty and glucocorticoid (GC) morbidity are among the highest concerns of clinicians and patients in this disease area. The positive news is that fast track pathways, imaging techniques and new therapies are emerging for routine management of GCA. Future directions for intervention in the treatment paradigm will be discussed.

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Section: Leflunomidementioning

confidence: 99%

A new era for giant cell arteritis

Lyons

Quick

Sinclair

et al. 2019

Eye

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“…those people with GCA who never achieve remission, this is typically a more accepted use of TCZ. Likewise, for those patients with glucocorticoid-induced side effects or patients with significant pre-existing comorbidities such as psychiatric disturbances, pancreatitis, or uncontrolled diabetes or hypertension, tocilizumab could be effective as a first line treatment [21,59].…”

Section: Recommendationmentioning

confidence: 99%

“…Advancing imaging techniques have demonstrated a larger portion of patients with large vessel involvement both with auxiliary ultrasound [19] and formal large vessel imaging studies [20]. In management of the disease, we now acknowledge that many patients with GCA are exposed to high cumulative doses of glucocorticoids (GC), resulting in significant increasing long-term [21]. The first ever therapy, Tocilizumab, that is specifically licensed for GCA and may be used as a GC-sparing agent, was given regulatory approval in 2017.…”

Section: Introductionmentioning

confidence: 99%

European Headache Federation recommendations for neurologists managing giant cell arteritis

et al. 2020

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Background and aim: Giant cell arteritis (GCA) remains a medical emergency because of the risk of sudden irreversible sight loss and rarely stroke along with other complications. Because headache is one of the cardinal symptoms of cranial GCA, neurologists need to be up to date with the advances in investigation and management of this condition. The aim of this document by the European Headache Federation (EHF) is to provide an evidence-based and expert-based recommendations on GCA. Methods: The working group identified relevant questions, performed systematic literature review and assessed the quality of available evidence, and wrote recommendations. Where there was not a high level of evidence, the multidisciplinary (neurology, ophthalmology and rheumatology) group recommended best practice based on their clinical experience. Results: Across Europe, fast track pathways and the utility of advanced imaging techniques are helping to reduce diagnostic delay and uncertainty, with improved clinical outcomes for patients. GCA is treated with high dose glucocorticoids (GC) as a first line agent however long-term GC toxicity is one of the key concerns for clinicians and patients. The first phase 2 and phase 3 randomised controlled trials of Tocilizumab, an IL-6 receptor antagonist, have been published. It is now been approved as the first ever licensed drug to be used in GCA. Conclusion: The present article will outline recent advances made in the diagnosis and management of GCA.

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“…4) [54,55]. The natural history of the disease varies, and because of the advent of targeted treatment disease stratification is required, with clear definitions of disease states ( Table 2) [8].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The mainstay of therapy in GCA has long been glucocorticoids (GC), which in themselves confer significant morbidity [6]. It is increasingly recognised that although GCA is traditionally seen as a GC-responsive disease, therapy typically lasts between 18 and 24 months with all requiring high dose therapy initially and some requiring long-term therapy, and when studied in the context of clinical trials only 15-20% of patients achieve long-term remission [7], highlighting the need for alternative therapies [8]. This review article is based on previously conducted studies and will present the recent advances in the diagnostic and therapeutic armamentarium in GCA.…”

Section: Introductionmentioning

confidence: 99%

Reviewing the Pathophysiology Behind the Advances in the Management of Giant Cell Arteritis

et al. 2019

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Improving understanding of the underlying pathophysiology of giant cell arteritis (GCA) is transforming clinical management by identifying novel avenues for targeted therapies. One key area of concern for both clinicians and patients with GCA is glucocorticoid (GC) morbidity. The first randomised controlled trials of targeted treatment to reduce cumulative GC use in GCA have been published, with tocilizumab, an interleukin (IL)-6 receptor inhibitor, now the first ever licensed treatment for GCA. Further potential therapies are emerging owing to our enhanced understanding of the pathophysiology of the disease. Other improvements in the care of our patients are rapid access pathways and imaging techniques, such as ultrasound, which are becoming part of modern rheumatology practice in the UK, Europe and beyond. These have been highlighted in the literature to reduce delay in diagnosis and improve long-term outcomes for those investigated for GCA.

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Giant cell arteritis: new concepts, treatments and the unmet need that remains

Cited by 20 publications

References 8 publications

A new era for giant cell arteritis

A new era for giant cell arteritis

European Headache Federation recommendations for neurologists managing giant cell arteritis

Reviewing the Pathophysiology Behind the Advances in the Management of Giant Cell Arteritis

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