Relapse after cessation of weekly tocilizumab for giant cell arteritis: a multicentre service evaluation in England

Vanessa Quick¹, Mahdi Abusalameh², Sajeel Ahmed³, Hoda Alkoky¹, Marwan Bukhari^{4

5}, Stuart Carter⁶, Fiona L Coath⁷, Brian Davidson⁸, Parveen Doddamani⁹, Shirish Dubey^{10

11}, Georgina Ducker¹², Bridget Griffiths³, Nicola Gullick^{13

14}, Jonathan Heaney³, Amelia Holloway¹⁵, Ei Ei Phyu Htut¹⁶, Mark Hughes¹⁷, Hannah Irvine¹⁰, Alison Kinder⁹, Asim Kurshid¹⁸, Joyce Lim¹⁹, Dalia R Ludwig²⁰, Mariam Malik⁸, Louise Mercer²¹, Ben Mulhearn^{22

23}, Jagdish R Nair^{24

25}, Rikesh Patel²⁶, Joanna Robson^{27

28}, Pratyasha Saha¹², Sarah Tansley^{22

23}; TOC STOP 2022 Investigators; Sarah L Mackie^{19

29}

Collaborators, Affiliations

Collaborators

TOC STOP 2022 Investigators:
Saad Ahmed, Ismael Atchia, James Bluett, Alex Connew, Elizabeth Coulson, Helena Crawshaw, Ursula Davies, Denise De Lord, Gurdeep Dulay, Amanda Embuldeniya, Carmen Fonseca, James Galloway, William Gubbins, Thushyanthan Guruparan, Rebecca Heaton, Martin James, Shalini Janagan, Hilary Johnson, Areej Karim, Salema Khalid, Kath Kinsey, Gouri Koduri, Stuart Linton, Elizabeth MacPhie, Arti Mahto, Chetan Mukhtyar, Anupama C Nandagudi, Pradip Nandi, Fathelrahman Osman, Sophie Plumb, Eavan Quinlan, Angela Redfern, Marian Regan, Vanessa Reid, Dipak Roy, Sadaf Saeed, Abbey Smith, Lauren Steel, Rhys Thomas, Adaeze Ugwoke, Sarah Villar, Emma Williams, Fiona Wood, Mingrui Xie

Affiliations

¹ Rheumatology Department, Luton and Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK.
² Rheumatology Department, Royal Devon University Healthcare NHS Foundation Trust, Devon, UK.
³ Rheumatology Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
⁴ Lancaster University, Lancaster, UK.
⁵ Rheumatology Department, Royal Lancaster Infirmary, Lancaster, UK.
⁶ Rheumatology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
⁷ Rheumatology Department, Southend University Hospital NHS Trust, Southend, UK.
⁸ Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁹ Rheumatology Department, University Hospitals of Leicester NHS Trust, Leicester, UK.
¹⁰ Department of Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
¹¹ Nuffield Dept of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
¹² Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
¹³ Rheumatology Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.
¹⁴ Rheumatology Department, Coventry & Warwick Medical School, University of Warwick, Warwick, UK.
¹⁵ Rheumatology Department, Kings College Hospital NHS Foundation Trust, London, UK.
¹⁶ Department of Rheumatology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
¹⁷ Rheumatology Department, Royal Cornwall Hospitals NHS Trust, Cornwall, UK.
¹⁸ Rheumatology Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK.
¹⁹ Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
²⁰ Rheumatology Department, University College London NHS Foundation Trust, London, UK.
²¹ Rheumatology Department, Stockport NHS Foundation Trust, Stockport, UK.
²² Department of Life Sciences, University of Bath, Bath, UK.
²³ Royal United Hospital for Rheumatic Diseases, Royal United Hospitals Bath, Bath, UK.
²⁴ Rheumatology Department, Liverpool University Hospitals (Aintree), Liverpool, UK.
²⁵ The National Behcet's Centre of Excellence, Liverpool, UK.
²⁶ Rheumatology Department, Manchester University Foundation NHS Trust, Manchester Royal Infirmary, Manchester, UK.
²⁷ Centre for Health and Clinical Research, University of the West of England, Bristol, UK.
²⁸ Department of Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
²⁹ NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

PMID: 37952183
DOI: 10.1093/rheumatology/kead604

Free article

Multicenter Study

Relapse after cessation of weekly tocilizumab for giant cell arteritis: a multicentre service evaluation in England

Vanessa Quick et al. Rheumatology (Oxford). 2024.

Free article

. 2024 Dec 1;63(12):3407-3414.

doi: 10.1093/rheumatology/kead604.

Authors

Collaborators

TOC STOP 2022 Investigators:
Saad Ahmed, Ismael Atchia, James Bluett, Alex Connew, Elizabeth Coulson, Helena Crawshaw, Ursula Davies, Denise De Lord, Gurdeep Dulay, Amanda Embuldeniya, Carmen Fonseca, James Galloway, William Gubbins, Thushyanthan Guruparan, Rebecca Heaton, Martin James, Shalini Janagan, Hilary Johnson, Areej Karim, Salema Khalid, Kath Kinsey, Gouri Koduri, Stuart Linton, Elizabeth MacPhie, Arti Mahto, Chetan Mukhtyar, Anupama C Nandagudi, Pradip Nandi, Fathelrahman Osman, Sophie Plumb, Eavan Quinlan, Angela Redfern, Marian Regan, Vanessa Reid, Dipak Roy, Sadaf Saeed, Abbey Smith, Lauren Steel, Rhys Thomas, Adaeze Ugwoke, Sarah Villar, Emma Williams, Fiona Wood, Mingrui Xie

Affiliations

¹ Rheumatology Department, Luton and Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK.
² Rheumatology Department, Royal Devon University Healthcare NHS Foundation Trust, Devon, UK.
³ Rheumatology Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
⁴ Lancaster University, Lancaster, UK.
⁵ Rheumatology Department, Royal Lancaster Infirmary, Lancaster, UK.
⁶ Rheumatology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
⁷ Rheumatology Department, Southend University Hospital NHS Trust, Southend, UK.
⁸ Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁹ Rheumatology Department, University Hospitals of Leicester NHS Trust, Leicester, UK.
¹⁰ Department of Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
¹¹ Nuffield Dept of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
¹² Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
¹³ Rheumatology Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.
¹⁴ Rheumatology Department, Coventry & Warwick Medical School, University of Warwick, Warwick, UK.
¹⁵ Rheumatology Department, Kings College Hospital NHS Foundation Trust, London, UK.
¹⁶ Department of Rheumatology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
¹⁷ Rheumatology Department, Royal Cornwall Hospitals NHS Trust, Cornwall, UK.
¹⁸ Rheumatology Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK.
¹⁹ Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
²⁰ Rheumatology Department, University College London NHS Foundation Trust, London, UK.
²¹ Rheumatology Department, Stockport NHS Foundation Trust, Stockport, UK.
²² Department of Life Sciences, University of Bath, Bath, UK.
²³ Royal United Hospital for Rheumatic Diseases, Royal United Hospitals Bath, Bath, UK.
²⁴ Rheumatology Department, Liverpool University Hospitals (Aintree), Liverpool, UK.
²⁵ The National Behcet's Centre of Excellence, Liverpool, UK.
²⁶ Rheumatology Department, Manchester University Foundation NHS Trust, Manchester Royal Infirmary, Manchester, UK.
²⁷ Centre for Health and Clinical Research, University of the West of England, Bristol, UK.
²⁸ Department of Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
²⁹ NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

PMID: 37952183
DOI: 10.1093/rheumatology/kead604

Abstract

Objectives: The National Health Service in England funds 12 months of weekly s.c. tocilizumab (qwTCZ) for patients with relapsing or refractory GCA. During the coronavirus disease 2019 (COVID-19) pandemic, some patients were allowed longer treatment. We sought to describe what happened to patients after cessation of qwTCZ.

Methods: Multicentre service evaluation of relapse after stopping qwTCZ for GCA. The log-rank test was used to identify significant differences in time to relapse.

Results: A total of 336 GCA patients were analysed from 40 centres, treated with qwTCZ for a median [interquartile range (IQR)] of 12 (12-17) months. At time of stopping qwTCZ, median (IQR) prednisolone dose was 2 (0-5) mg/day. By 6, 12 and 24 months after stopping qwTCZ, 21.4%, 35.4% and 48.6%, respectively, had relapsed, requiring an increase in prednisolone dose to a median (IQR) of 20 (10-40) mg/day. 33.6% relapsers had a major relapse as defined by EULAR. Time to relapse was shorter in those that had previously also relapsed during qwTCZ treatment (P = 0.0017), in those not in remission at qwTCZ cessation (P = 0.0036) and in those with large vessel involvement on imaging (P = 0.0296). Age ≥65 years, gender, GCA-related sight loss, qwTCZ treatment duration, TCZ taper, prednisolone dosing and conventional synthetic DMARD use were not associated with time to relapse.

Conclusion: Up to half our patients with GCA relapsed after stopping qwTCZ, often requiring a substantial increase in prednisolone dose. One-third of relapsers had a major relapse. Extended use of TCZ or repeat treatment for relapse should be considered for these patients.

Keywords: NICE guidance; giant cell arteritis; relapse; service evaluation; tocilizumab; vasculitis.

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Relapse after cessation of weekly tocilizumab for giant cell arteritis: a multicentre service evaluation in England

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Relapse after cessation of weekly tocilizumab for giant cell arteritis: a multicentre service evaluation in England

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