OBJECTIVE Tocilizumab (TCZ) is effective for giant cell arteritis (GCA). However, little is known regarding treatment modification and clinical outcomes after unfavorable events, such as GCA relapses or TCZ discontinuation due to adverse events (AEs). METHODS This multicenter retrospective study included GCA patients who initiated TCZ from 2008 to 2021 at five Japanese hospitals. GCA relapses and TCZ-related AEs were monitored for two years after TCZ initiation. In patients with GCA relapses, subsequent clinical courses, including relapse symptoms and treatment modification, were followed for 90 days after the relapses. Similarly, patients who discontinued TCZ due to AEs were additionally followed until one year after the TCZ discontinuation to evaluate AEs, relapses, and treatment changes. RESULTS Of 62 eligible patients, 10 patients (16%) relapsed after initiating TCZ therapy. Most relapses (8/10) occurred after extending TCZ intervals or discontinuing TCZ. Combinations of adjusting TCZ intervals, glucocorticoid (GC), and/or methotrexate (MTX) could manage the relapses without serious complications. In the entire cohort, AEs occurred in 28 patients (45%), and 8 patients (13%) discontinued TCZ due to AEs. After AE-related TCZ discontinuation, six patients attempted to taper GC without other immunosuppressive treatments, and four subsequently relapsed. In contrast, two patients who used other immunosuppressants or biological therapy could decrease GC without relapses. CONCLUSION Although GCA relapses can occur after initiating TCZ therapy, most relapses can be safely managed by adjusting TCZ, GC, and/or MTX. Adding immunosuppressants or biological treatments may potentially be related to preventing relapses when patients discontinue TCZ due to AEs.

中文翻译：

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托珠单抗治疗巨细胞动脉炎：复发和因不良事件停药托珠单抗后的临床结果。


目的 托珠单抗 （TCZ） 对巨细胞动脉炎 （GCA） 有效。然而，关于不良事件后治疗调整和临床结果知之甚少，例如 GCA 复发或因不良事件 （AE） 而停药 TCZ。方法 这项多中心回顾性研究包括 2008 年至 2021 年在日本 5 家医院开始 TCZ 的 GCA 患者。TCZ 开始后两年监测 GCA 复发和 TCZ 相关 AE。在 GCA 复发患者中，随访复发后 90 天的后续临床过程，包括复发症状和治疗调整。同样，因 AE 而停用 TCZ 的患者也接受了额外随访，直到 TCZ 停用后一年，以评估 AE 、复发和治疗变化。结果 在 62 例符合条件的患者中，10 例患者 （16%） 在开始 TCZ 治疗后复发。大多数复发 （8/10） 发生在延长 TCZ 间期或停止 TCZ 后。调整 TCZ 间期、糖皮质激素 （GC） 和/或甲氨蝶呤 （MTX） 的组合可以控制复发，而不会出现严重并发症。在整个队列中，28 例患者 （45%） 发生 AE，8 例患者 （13%） 因 AE 停止 TCZ。在 AE 相关 TCZ 停药后，6 例患者尝试在不进行其他免疫抑制治疗的情况下逐渐减少 GC，4 例随后复发。相比之下，两名使用其他免疫抑制剂或生物疗法的患者可以降低 GC 而不会复发。结论 虽然 GCA 复发可能发生在 TCZ 治疗开始后，但大多数复发可以通过调整 TCZ 、 GC 和/或 MTX 来安全控制。当患者因 AE 停止 TCZ 时，添加免疫抑制剂或生物治疗可能与防止复发有关。