How Long Should Tocilizumab Be Continued for Patients with Giant Cell Arteritis?


John Stone, MD, Massachusetts General Hospital, discussed study results and fear surrounding giant cell arteritis.

"Giant cell arteritis is a disease that has huge unmet need ever since cortisone was invented 67 years ago," said John Stone, MD, Massachusetts General Hospital. Stone explained that the only existing treatment, glucocorticoids (prednisone), while effective, is associated with a host of side effects, making it difficult to maintain patients on prednisone for a long period of time. Stone and his team embarked on the GiACTA study, whose goal was to demonstrate that tocilizumab had a powerful "steroid-sparing" effect. To test their hypothesis, the team embarked on a trial with four arms and 251 patients.

According to Stone, one of the most striking findings was that in the steroid-only arm (in the patients who received one full year of steroids) only 18% of patients were in sustained remission at one year. Also, the tocilizumab group faired much better with regard to achievement of sustaining remission. Stone believed that the take-home point should be that when physicians diagnose patients with giant cell arteristis, they need to think not only of steroids immediately; instead they need to think about promptly beginning tocilizumab. It's important to note that all the while, the patient is absorbing the toxicity of the glucocorticoid, so it's important to think about using both of the medicines together and eventually tapering the steroids off as quickly as possible.

Stone shared that one of the exciting questions in the months and years to come is how little glucocorticoid they can use in treating these patients, and about how long tocilizumab should be continued - something they plan to study in the second leg of the trial.

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