Loricera Javier, Castañeda Santos, Moriano Clara, Narváez Javier, Aldasoro Vicente, Maiz Olga, Melero Rafael, Villa Ignacio, Vela Paloma, Romero-Yuste Susana, Callejas José L, de Miguel Eugenio, Galíndez-Agirregoikoa Eva, Sivera Francisca, Fernández-López Jesús C, Galisteo Carles, Ferraz-Amaro Iván, Sánchez-Martín Julio, Sánchez-Bilbao Lara, Calderón-Goercke Mónica, Casado Alfonso, Hernández José L, González-Gay Miguel A, Blanco Ricardo
Rheumatology Division, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Catedra UAM-Roche, EPID-Future, UAM, Madrid, Spain.
Ther Adv Musculoskelet Dis. 2022 Jul 22;14:1759720X221113747. doi: 10.1177/1759720X221113747. eCollection 2022.
Visual involvement is the most feared complication of giant cell arteritis (GCA). Information on the efficacy of tocilizumab (TCZ) for this complication is scarce and controversial.
We assessed a wide series of GCA treated with TCZ, to evaluate its role in the prevention of new visual complications and its efficacy when this manifestation was already present before the initiation of TCZ.
This is an observational multicenter study of patients with GCA treated with TCZ.
Patients were divided into two subgroups according to the presence or absence of visual involvement before TCZ onset. Visual manifestations were classified into the following categories: transient visual loss (TVL), permanent visual loss (PVL), diplopia, and blurred vision.
Four hundred seventy-one GCA patients (mean age, 74 ± 9 years) were treated with TCZ. Visual manifestations were observed in 122 cases (26%), of which 81 were present at TCZ onset: PVL ( = 60; unilateral/bilateral: 48/12), TVL ( = 17; unilateral/bilateral: 11/6), diplopia ( = 2), and blurred vision ( = 2). None of the patients without previous visual involvement or with TVL had new episodes after initiation of TCZ, while only 11 out of 60 (18%) patients with PVL experienced some improvement. The two patients with diplopia and one of the two patients with blurred vision improved.
TCZ may have a protective effect against the development of visual complications or new episodes of TVL in GCA. However, once PVL was established, only a few patients improved.
视力受累是巨细胞动脉炎（GCA）最令人担忧的并发症。关于托珠单抗（TCZ）治疗该并发症疗效的信息匮乏且存在争议。
我们评估了接受TCZ治疗的一系列GCA患者，以评估其在预防新的视力并发症方面的作用，以及在TCZ开始治疗前就已出现该表现时的疗效。
这是一项对接受TCZ治疗的GCA患者进行的观察性多中心研究。
根据TCZ开始治疗前是否存在视力受累将患者分为两个亚组。视力表现分为以下几类：短暂性视力丧失（TVL）、永久性视力丧失（PVL）、复视和视力模糊。
471例GCA患者（平均年龄74±9岁）接受了TCZ治疗。122例（26%）出现视力表现，其中81例在TCZ开始治疗时就已存在：PVL（n = 60；单侧/双侧：48/12）、TVL（n = 17；单侧/双侧：11/6）、复视（n = 2）和视力模糊（n = 2）。既往无视力受累或有TVL的患者在开始使用TCZ后均未出现新的发作，而60例PVL患者中只有11例（18%）有所改善。两名复视患者和两名视力模糊患者中的一名有所改善。
TCZ可能对GCA患者视力并发症的发生或TVL的新发作具有保护作用。然而，一旦出现PVL，只有少数患者有所改善。
