Seminars in arthritis and rheumatism · 2025
Tocilizumab monotherapy versus combined in aortitis associated with giant cell arteritis: Factors associated with imaging remission in a multicenter open-label study of 196 patients.
Сравнительное исследованиеСтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Martín-Gutiérrez Adrián, Loricera Javier, Prieto-Peña Diana, Aldasoro Vicente, Maiz Olga, de Miguel Eugenio, Galíndez-Agirregoikoa Eva, Ferraz-Amaro Iván, Castañeda Santos, Blanco Ricardo, Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group
Аннотация
BACKGROUND: Aortitis is a frequent and potentially serious complication of giant cell arteritis (GCA). The phenotype associated with aortitis (GCA-aortitis) can present greater therapeutic challenges than the cranial-dominant phenotype. Tocilizumab (TCZ) is approved for GCA, although its efficacy in GCA-aortitis has not been specifically assessed in randomized controlled trials.
OBJECTIVE: To assess the effectiveness and safety of TCZ monotherapy (TCZmono) compared with TCZ plus conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) (TCZcombo) in patients with GCA-aortitis in real-world practice, and to identify variables associated with imaging remission.
METHODS: A multicenter observational study comparing TCZcombo versus TCZmono. Outcomes at 12 and 24 months included clinical remission, EULAR-defined remission, imaging remission, prednisone-sparing effect, and safety. Multivariable logistic regression identified factors linked to imaging remission at 24 months.
RESULTS: A total of 196 patients (148 female, 48 male) with GCA-aortitis received TCZ (136 TCZmono, 60 TCZcombo). At 24 months, imaging remission was higher in the TCZcombo group (50.0%¦vs. 15.8%; p=0.026). No significant differences were found in clinical or EULAR-defined remission. TCZcombo demonstrated a prednisone-sparing effect. The serious adverse event (SAE) rate was numerically lower with TCZcombo (8.7 vs. 13.2 per 100 patient-years; p=0.21). TCZcombo increased the odds of imaging remission 5.26-fold (odds ratio [OR] 5.26; 95% confidence interval [CI]: 1.03-26.85; p=0.046).
CONCLUSION: In patients with GCA-aortitis, TCZcombo may be more effective than TCZmono in achieving imaging remission and promoting glucocorticoid tapering, but without definitive evidence regarding a reduction of serious adverse events.
OBJECTIVE: To assess the effectiveness and safety of TCZ monotherapy (TCZmono) compared with TCZ plus conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) (TCZcombo) in patients with GCA-aortitis in real-world practice, and to identify variables associated with imaging remission.
METHODS: A multicenter observational study comparing TCZcombo versus TCZmono. Outcomes at 12 and 24 months included clinical remission, EULAR-defined remission, imaging remission, prednisone-sparing effect, and safety. Multivariable logistic regression identified factors linked to imaging remission at 24 months.
RESULTS: A total of 196 patients (148 female, 48 male) with GCA-aortitis received TCZ (136 TCZmono, 60 TCZcombo). At 24 months, imaging remission was higher in the TCZcombo group (50.0%¦vs. 15.8%; p=0.026). No significant differences were found in clinical or EULAR-defined remission. TCZcombo demonstrated a prednisone-sparing effect. The serious adverse event (SAE) rate was numerically lower with TCZcombo (8.7 vs. 13.2 per 100 patient-years; p=0.21). TCZcombo increased the odds of imaging remission 5.26-fold (odds ratio [OR] 5.26; 95% confidence interval [CI]: 1.03-26.85; p=0.046).
CONCLUSION: In patients with GCA-aortitis, TCZcombo may be more effective than TCZmono in achieving imaging remission and promoting glucocorticoid tapering, but without definitive evidence regarding a reduction of serious adverse events.