• Adrián Martín-Gutiérrez, Javier Loricera, Javier Narváez, Vicente Aldasoro, Olga Maiz, Paloma Vela, Susana Romero-Yuste, Eugenio de Miguel, Eva Galíndez-Agirregoikoa, Jesús C Fernández-López, Iván Ferraz-Amaro, Julio Sánchez-Martín, Patricia Moya, Cristina Campos, Fernando López-Gutiérrez, Santos Castañeda, Ricardo Blanco, and Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group.
• Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Immunopathology Group, Santander, Spain.
• Eur. J. Intern. Med. 2024 Nov 1; 129: 788678-86.

ObjectiveAortitis in Giant Cell Arteritis (GCA-aortitis) is a frequent complication that may lead to aneurysms. Tocilizumab (TCZ) was approved in GCA, but the efficacy in GCA-aortitis and aneurysms has not been analyzed to date. Our aim was to assess the effectiveness and safety of TCZ in a wide series of GCA-aortitis and aneurysms.MethodsMulticentre observational study with GCA-aortitis treated with TCZ. GCA was diagnosed by: a) ACR criteria, b) temporal artery biopsy, and/or c) imaging techniques. Aortitis was diagnosed mainly by PET/CT. Main outcomes were EULAR and imaging remission. Others were clinical remission, analytical normalization, corticosteroid-sparing effect, and the prevention and improvement of aneurysms.Results196 patients with GCA-aortitis treated with TCZ. After 6 months, 72.2% reached EULAR remission but only 12% an imaging remission; increasing up-to 81.4% and 31.8%, respectively, at 24 months. A rapid clinical remission, ESR and CRP normalization was observed in 47.4%, 84.3% and 55.6%, at 1 month, increasing to 89.6%, 85.3% and 80.3% at 24 months, respectively. Aneurysms were present in 10 (5%) patients. Five of them required early surgery, while 3 others enlarged. No patient on TCZ therapy developed aneurysms during follow-up.ConclusionIn patients with GCA-aortitis treated with TCZ, a rapid and maintained clinical and analytical improvement was observed. However, there was an uncoupling between clinical and EULAR remission with imaging remission.Copyright © 2024 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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