Assessment of the efficacy and safety of tocilizumab in patients over 80 years old with giant cell arteritis
OBJECTIVE: To assess the efficacy and tolerance of tocilizumab (TCZ) in giant cell arteritis (GCA) patients over 80.
METHOD: GCA patients over 80 years old from the French Study Group for Large Vessel Vasculitis register who received TCZ were analyzed.
RESULTS: Twenty-one GCA patients (median age 84 [81-90] years old, including nine over 85) received TCZ for the following nonexclusive reasons: glucocorticoid (GC)-sparing effect in 14, relapsing disease in 8, disease severity in 4, and/or failure of another immunosuppressant in 4. TCZ was introduced with GCs at diagnosis in 6 patients and at 8 [3-37] months after GC initiation in 15 others. After a median delay of 8 [2-21] months post-TCZ introduction, 14 (67%) patients were able to definitively stop GCs, including 6 who were GC-dependent before TCZ. At the last follow-up (median 20 [3-48] months), 11 (52%) patients had definitively stopped TCZ, and 2 additional patients had stopped but relapsed and resumed TCZ. Seven (33%) patients experienced 11 adverse events: hypercholesterolemia in 4 patients; infections, i.e., pyelonephritis, bronchitis, and fatal septic shock associated with mesenteric infarction following planned surgery (GCs were stopped for 1 year and TCZ infusions for 2 months), respectively, in 3 patients; moderate thrombocytopenia and moderate neutropenia in 2 patients; and a 5-fold increase in transaminase levels in another that improved after TCZ dose reduction.
CONCLUSION: TCZ remains a valuable GC-sparing option in the oldest GCA patients with an interesting risk-benefit ratio. Mild-to-moderate adverse events were observed in one-third of patients.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:23 |
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| Enthalten in: |
Arthritis research & therapy - 23(2021), 1 vom: 19. Mai, Seite 143 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
de Boysson, Hubert [VerfasserIn] |
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| Links: |
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| Themen: |
Antibodies, Monoclonal, Humanized |
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| Anmerkungen: |
Date Completed 21.06.2021 Date Revised 21.06.2021 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s13075-021-02529-4 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM325610215 |
|---|
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| 245 | 1 | 0 | |a Assessment of the efficacy and safety of tocilizumab in patients over 80 years old with giant cell arteritis |
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| 500 | |a Date Revised 21.06.2021 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: To assess the efficacy and tolerance of tocilizumab (TCZ) in giant cell arteritis (GCA) patients over 80 | ||
| 520 | |a METHOD: GCA patients over 80 years old from the French Study Group for Large Vessel Vasculitis register who received TCZ were analyzed | ||
| 520 | |a RESULTS: Twenty-one GCA patients (median age 84 [81-90] years old, including nine over 85) received TCZ for the following nonexclusive reasons: glucocorticoid (GC)-sparing effect in 14, relapsing disease in 8, disease severity in 4, and/or failure of another immunosuppressant in 4. TCZ was introduced with GCs at diagnosis in 6 patients and at 8 [3-37] months after GC initiation in 15 others. After a median delay of 8 [2-21] months post-TCZ introduction, 14 (67%) patients were able to definitively stop GCs, including 6 who were GC-dependent before TCZ. At the last follow-up (median 20 [3-48] months), 11 (52%) patients had definitively stopped TCZ, and 2 additional patients had stopped but relapsed and resumed TCZ. Seven (33%) patients experienced 11 adverse events: hypercholesterolemia in 4 patients; infections, i.e., pyelonephritis, bronchitis, and fatal septic shock associated with mesenteric infarction following planned surgery (GCs were stopped for 1 year and TCZ infusions for 2 months), respectively, in 3 patients; moderate thrombocytopenia and moderate neutropenia in 2 patients; and a 5-fold increase in transaminase levels in another that improved after TCZ dose reduction | ||
| 520 | |a CONCLUSION: TCZ remains a valuable GC-sparing option in the oldest GCA patients with an interesting risk-benefit ratio. Mild-to-moderate adverse events were observed in one-third of patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Efficacy | |
| 650 | 4 | |a Elderly | |
| 650 | 4 | |a Giant cell arteritis | |
| 650 | 4 | |a Old patients | |
| 650 | 4 | |a Safety | |
| 650 | 4 | |a Tocilizumab | |
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| 700 | 1 | |a Blaison, Félix |e verfasserin |4 aut | |
| 700 | 1 | |a Daumas, Aurélie |e verfasserin |4 aut | |
| 700 | 1 | |a Jarrot, Pierre-André |e verfasserin |4 aut | |
| 700 | 1 | |a Perrin, François |e verfasserin |4 aut | |
| 700 | 1 | |a Tieulié, Nathalie |e verfasserin |4 aut | |
| 700 | 1 | |a Maria, Alexandre |e verfasserin |4 aut | |
| 700 | 1 | |a Duffau, Pierre |e verfasserin |4 aut | |
| 700 | 1 | |a Gombert, Bruno |e verfasserin |4 aut | |
| 700 | 1 | |a Samson, Maxime |e verfasserin |4 aut | |
| 700 | 1 | |a Espitia, Olivier |e verfasserin |4 aut | |
| 700 | 1 | |a Lambert, Marc |e verfasserin |4 aut | |
| 700 | 1 | |a Mékinian, Arsène |e verfasserin |4 aut | |
| 700 | 1 | |a Aouba, Achille |e verfasserin |4 aut | |
| 700 | 0 | |a French Study Group for Large Vessel Vasculitis (GEFA) |e verfasserin |4 aut | |
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