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Real-world risk of relapse of giant cell arteritis treated with tocilizumab: A retrospective analysis of 43 patients

dc.rights.licenseopenen_US
dc.contributor.authorCLEMENT, Jeremy
dc.contributor.authorDUFFAU, Pierre
dc.contributor.authorCONSTANS, Joel
dc.contributor.authorSCHAEVERBEKE, Thierry
dc.contributor.authorVIALLARD, Jean-Francois
dc.contributor.authorBARCAR, Damien
dc.contributor.authorVERNHES, Jean-Philippe
dc.contributor.authorSAILLER, Laurent
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorBONNET, Fabrice
dc.date.accessioned2021-04-02T08:50:45Z
dc.date.available2021-04-02T08:50:45Z
dc.date.issued2021-02
dc.identifier.issn0315-162X (Print)en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/26854
dc.description.abstractEnOBJECTIVE: Tocilizumab (TCZ), an IL-6 receptor antagonist, is approved for giant cell arteritis (GCA) as a cortisone-sparing strategy and in refractory patients. This study assessed the real-world efficacy, safety, and long-term outcomes of GCA patients treated with TCZ. METHODS: We conducted a multicenter retrospective observational study at three French centers. All patients ≥ 50 years, meeting the American College of Rheumatology (ACR) criteria, and had received at least one dose of TCZ were included. Relapse was defined by therapeutic escalation, such as increased doses of CS, resumption of CS after weaning, or introduction or intensification of adjuvant therapy. RESULTS: Between 2013 and 2019, 43 patients were included. Patients were followed-up in median 511 days between GCA diagnosis and inclusion with 34/43 (72%) patients experiencing relapses. At inclusion, median age was 77 years and median dose of corticosteroid (CS) was 15 mg/day. After inclusion, the mean cumulative dose of CS was 2.1g/year versus 9.4g/year before inclusion (p\textbackslashtextless2.10(7)) with 12/43 (28%) patients experiencing relapses on TCZ. Among 29 patients undergoing TCZ discontinuation, 18 (62%) experienced relapse. Factors associated with relapse after inclusion were introduction of TCZ \textbackslashtextgreater 6 months after diagnosis (p=0,005), absence of ischemic signs at diagnosis (p=0,006), relapse rate \textbackslashtextgreater0.8/year (p=0.03) and absence of CS tapering ≤ 5 mg/day (p=0,03) before inclusion. Serious adverse events occurred in 18/43 patients (42%), including four deaths. CONCLUSION: Our results confirm the effectiveness of TCZ for CS-sparing, but after discontinuation of treatment, TCZ allows for a prolonged remission in less than 50% of patients. Attention must be paid to the tolerance of this long-term treatment in this elderly and heavily treated population.
dc.language.isoENen_US
dc.title.enReal-world risk of relapse of giant cell arteritis treated with tocilizumab: A retrospective analysis of 43 patients
dc.title.alternativeJ Rheumatolen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.3899/jrheum.200952en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed33589561en_US
bordeaux.journalJournal of Rheumatologyen_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.teamMORPH3Eusen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-03188558
hal.version1
hal.date.transferred2021-04-02T08:50:49Z
hal.audienceInternationale
hal.exporttrue
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