Quick Vanessa, Abusalameh Mahdi, Ahmed Sajeel, Alkoky Hoda, Bukhari Marwan, Carter Stuart, Coath Fiona L, Davidson Brian, Doddamani Parveen, Dubey Shirish, Ducker Georgina, Griffiths Bridget, Gullick Nicola, Heaney Jonathan, Holloway Amelia, Htut Ei Ei Phyu, Hughes Mark, Irvine Hannah, Kinder Alison, Kurshid Asim, Lim Joyce, Ludwig Dalia R, Malik Mariam, Mercer Louise, Mulhearn Ben, Nair Jagdish R, Patel Rikesh, Robson Joanna, Saha Pratyasha, Tansley Sarah, Mackie Sarah L
Rheumatology Department, Luton and Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK.
Rheumatology Department, Royal Devon University Healthcare NHS Foundation Trust, Devon, UK.
Rheumatology (Oxford). 2024 Dec 1;63(12):3407-3414. doi: 10.1093/rheumatology/kead604.
The National Health Service in England funds 12 months of weekly s.c. tocilizumab (qwTCZ) for patients with relapsing or refractory GCA. During the coronavirus disease 2019 (COVID-19) pandemic, some patients were allowed longer treatment. We sought to describe what happened to patients after cessation of qwTCZ.
Multicentre service evaluation of relapse after stopping qwTCZ for GCA. The log-rank test was used to identify significant differences in time to relapse.
A total of 336 GCA patients were analysed from 40 centres, treated with qwTCZ for a median [interquartile range (IQR)] of 12 (12-17) months. At time of stopping qwTCZ, median (IQR) prednisolone dose was 2 (0-5) mg/day. By 6, 12 and 24 months after stopping qwTCZ, 21.4%, 35.4% and 48.6%, respectively, had relapsed, requiring an increase in prednisolone dose to a median (IQR) of 20 (10-40) mg/day. 33.6% relapsers had a major relapse as defined by EULAR. Time to relapse was shorter in those that had previously also relapsed during qwTCZ treatment (P = 0.0017), in those not in remission at qwTCZ cessation (P = 0.0036) and in those with large vessel involvement on imaging (P = 0.0296). Age ≥65 years, gender, GCA-related sight loss, qwTCZ treatment duration, TCZ taper, prednisolone dosing and conventional synthetic DMARD use were not associated with time to relapse.
Up to half our patients with GCA relapsed after stopping qwTCZ, often requiring a substantial increase in prednisolone dose. One-third of relapsers had a major relapse. Extended use of TCZ or repeat treatment for relapse should be considered for these patients.
英国国家医疗服务体系为复发型或难治性巨细胞动脉炎（GCA）患者提供为期12个月的每周皮下注射托珠单抗（qwTCZ）治疗。在2019年冠状病毒病（COVID-19）大流行期间，一些患者被允许接受更长时间的治疗。我们试图描述qwTCZ停药后患者的情况。
对GCA患者停用qwTCZ后的复发情况进行多中心服务评估。采用对数秩检验来确定复发时间的显著差异。
共分析了来自40个中心的336例GCA患者，接受qwTCZ治疗的中位时间[四分位间距（IQR）]为12（12 - 17）个月。在停用qwTCZ时，泼尼松龙剂量的中位值（IQR）为2（0 - 5）mg/天。停用qwTCZ后6个月、12个月和24个月时，分别有21.4%、35.4%和48.6%的患者复发，需要将泼尼松龙剂量增加至中位值（IQR）为20（10 - 40）mg/天。33.6%的复发患者出现了欧洲抗风湿病联盟（EULAR）定义的严重复发。在qwTCZ治疗期间曾复发过的患者（P = 0.0017）、在停用qwTCZ时未缓解的患者（P = 0.0036）以及影像学显示有大血管受累的患者（P = 0.0296），其复发时间较短。年龄≥65岁、性别、与GCA相关的视力丧失、qwTCZ治疗持续时间、托珠单抗减量、泼尼松龙给药以及传统合成改善病情抗风湿药的使用与复发时间无关。
我们高达一半的GCA患者在停用qwTCZ后复发，通常需要大幅增加泼尼松龙剂量。三分之一的复发患者出现了严重复发。对于这些患者，应考虑延长托珠单抗的使用时间或对复发进行重复治疗。
