Institute for Infection & Immunity, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.
J Med Case Rep. 2022 Oct 27;16(1):389. doi: 10.1186/s13256-022-03625-y.
Giant cell arteritis is a large vessel vasculitis of the arteries in the head and neck. The mainstay of management is with high-dose corticosteroids, and patients often face difficulties stopping or reducing steroids without recurrence of symptoms. Corticosteroids are well established to have numerous associated side effects, including osteoporosis, weight gain, and diabetes. Therefore, when tocilizumab was approved for up to 1 year for cases of relapsing or refractory giant cell arteritis by the National Institute of Health and Care Excellence (NICE) in April 2018, this offered an opportunity to benefit from new funding and to reduce steroid burden.
This case series describes the impact of the establishment of a new hub and spoke referral pathway for the use of tocilizumab in refractory or relapsing giant cell arteritis, with case examples from consecutive patients who accessed the funding between August 2018 and April 2021. A total of 16 patients were identified: 11 female and 5 male, with an average age of 72.4 (range 61-82) years, with a majority of 11 ethnically white. The central assessing hub is St George's University Hospitals NHS Foundation Trust Hospital, serving a population of 1.3 million in the south of England. This is the first large case series looking into the impact of the establishment of a regional clinical pathway for the new tocilizumab funding.
The case series demonstrates that the use of tocilizumab has reduced both the duration and the dose of corticosteroids in these 16 cases (mean prednisolone reduction 20.4 mg: 95% CI 13.0-27.8 mg), with 50% of patients continuing on tocilizumab after the initial 12 month funding period. The disease course, patterns of response, and maintenance of remission are discussed, and we describe the benefits of replicating this hub and spoke tocilizumab pathway in other centers.
巨细胞动脉炎是头颈部动脉的大血管血管炎。治疗的主要方法是使用大剂量皮质类固醇，而患者在不复发症状的情况下停药或减少类固醇往往会面临困难。皮质类固醇已被广泛证实具有许多相关的副作用，包括骨质疏松症、体重增加和糖尿病。因此，当国家卫生与保健卓越研究所（NICE）在 2018 年 4 月批准托珠单抗用于复发或难治性巨细胞动脉炎的治疗，最长可达 1 年时，这为受益于新的资金和减少类固醇负担提供了机会。
本病例系列描述了为难治性或复发性巨细胞动脉炎建立新的枢纽和分支转诊途径以使用托珠单抗的影响，并提供了 2018 年 8 月至 2021 年 4 月期间获得资金的连续患者的病例示例。共确定了 16 例患者：11 名女性和 5 名男性，平均年龄 72.4 岁（范围 61-82 岁），大多数为 11 名白种人。中央评估枢纽是圣乔治大学医院 NHS 基金会信托医院，为英格兰南部 130 万人口提供服务。这是第一个研究建立新托珠单抗资金区域临床途径对影响的大型病例系列。
该病例系列表明，在这 16 例患者中，托珠单抗的使用减少了皮质类固醇的持续时间和剂量（平均泼尼松龙减少 20.4mg：95%置信区间 13.0-27.8mg），其中 50%的患者在初始 12 个月资金期后继续使用托珠单抗。讨论了疾病过程、反应模式和缓解维持情况，并描述了在其他中心复制这种枢纽和分支托珠单抗途径的益处。
