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Multicenter Study
. 2025 Feb 10;45(3):45.
doi: 10.1007/s00296-025-05796-5.

A feasible treatment strategy for tapering subcutaneous tocilizumab in giant cell arteritis: a 24-month multi-center retrospective study

Takanori Ito  1 , Sho Fukui  2   3   4 , Fumika N Nagase  5 , Toshihiro Yamaguchi  6 , Nobuhiro Oda  7 , Hajime Inokuchi  7   8 , Masei Suda  6 , Naoho Takizawa  5 , Yasuhiro Suyama  9 , Ryo Rokutanda  7 , Atsushi Nomura  10 , Eishi Uechi  11 , Yoichiro Haji  1 , Hiromichi Tamaki  12
Affiliations
Multicenter Study

A feasible treatment strategy for tapering subcutaneous tocilizumab in giant cell arteritis: a 24-month multi-center retrospective study

Takanori Ito et al. Rheumatol Int. .

Abstract

To examine whether extending tocilizumab (TCZ) intervals is a feasible treatment strategy in giant cell arteritis (GCA). This multicenter retrospective study included patients with GCA who started subcutaneous TCZ at five Japanese hospitals between January 2008 and July 2021. We collected clinical data and monitored relapses for up to 24 months following the initiation of TCZ. The treatment regimen, including TCZ intervals and glucocorticoid (GC) dosage, was evaluated every 6 months. Of 56 eligible patients, 44 (79%) initiated TCZ weekly, and 12 (21%) every two weeks. The GC dosage consistently decreased after initiating TCZ; GC discontinuation was achieved in 87.5% at month 24. The number of patients extending TCZ intervals increased over time. Among the 32 patients who were followed at month 24, 5 (15.6%) continued weekly TCZ; the TCZ interval was every two weeks in 13 (40.6%), every three weeks in 7 (21.9%), and every four weeks or longer in 5 (15.6%), and 2 (6.3%) discontinued TCZ due to well-controlled disease. During 24-month follow-up, 10 (31.3%) extended TCZ intervals by two weeks or more from the starting dose. Three patients experienced relapses after extending TCZ intervals for well-controlled GCA, and all improved by shortening TCZ intervals. Gradually extending TCZ intervals by one week each is a feasible treatment strategy for well-controlled GCA patients after achieving GC-free status. While some patients may experience relapses following the extension of TCZ intervals, these relapses might be potentially managed by adjusting only the TCZ intervals.

Keywords: Drug tapering; Giant cell arteritis; Glucocorticoids; Recurrence; Tocilizumab.

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Conflict of interest statement

Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of St. Luke’s International Hospital (approval number: 20-R005, approval date: May 08, 2023). Consent to participate: We obtained informed consent by offering options for opting out. Disclaimers: No part of this manuscript, including the text and graphics, has been copied or published elsewhere, in whole or in part. The authors utilized an AI-based language model for minor language editing, including grammar and style checks. All intellectual content and scientific interpretations are the sole responsibility of the authors. Conflict of interest: TI received personal fees from Asahi Kasei Pharma, Sanofi, GSK, Eisai, Janssen Pharmaceutical, Boehringer Ingelheim, Taisho and Eli Lilly. NT received personal fees from AstraZeneca, Sanofi, Chugai Pharmaceutical, AbbVie, Tanabe-Mitsubishi, GSK, Pfizer, Eisai, Lilly, Taisho, and Novartis. YS received personal fees from Chugai Pharmaceutical. AN received personal fees from Asahi Kasei Pharma, Eisai, and Tanabe-Mitsubishi. HT received personal fees from AstraZeneca, Kissei Pharmaceutical, Asahi Kasei Pharma, Sanofi, Eisai, Chugai Pharmaceutical, AbbVie, Ono Pharmaceutical, Kyowa-Kirin, Takeda Pharmaceutical, Astellas Pharma, Tanabe-Mitsubishi, GSK, Pfizer, Dai-ichi-Sankyo, Lilly, and Ayumi. The other authors declare no conflicts of interest associated with this manuscript.

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