• Hubert de Boysson, Valérie Devauchelle-Pensec, Christian Agard, Marc André, Boris Bienvenu, Bernard Bonnotte, Guillermo Carvajal Alegria, Olivier Espitia, Eric Hachulla, Emmanuel Héron, Marc Lambert, Jean-Christophe Lega, Kim H Ly, Arsène Mekinian, Jacques Morel, Alexis Régent, Christophe Richez, Laurent Sailler, Raphaele Seror, Anne Tournadre, Maxime Samson, and Groupe d’étude français des artérites des gros vaisseaux (GEFA).
• Service de Médecine Interne et Immunologie Clinique, CHU de Caen, Caen, France. Electronic address: deboysson-h@chu-caen.fr.
• Rev Med Interne. 2024 Nov 4.

PurposeAn updated revision of the 2016 recommendations from the French Study Group for Large Vessel Vasculitis (GEFA) was needed to better delineate the place and management of immunosuppressants or biologics in giant cell arteritis (GCA).MethodsA panel of 18 physicians, including internists and rheumatologists, constituted the task force of this project and drafted the recommendations. Twelve additional readers were asked to analyse and comment on the recommendations. Two face-to-face virtual meetings were held to discuss and validate the recommendations. Each member voted individually, and a>85% consensus was required to validate each recommendation.ResultsFrom the initial 6 questions, 26 recommendations were validated. The following main recommendations were validated. (1) Subcutaneous 162mg tocilizumab (TCZ) for at least 12months should be used first when glucocorticoid (GC)-sparing treatment is needed with the objective of discontinuing GCs within the subsequent 6months. (2) GCA patients who have experienced any of the following conditions must receive TCZ at GCA diagnosis with 6months of GC therapy: major cardiovascular event, osteoporosis with fracture, psychiatric event with GC use, complicated diabetes mellitus, or any previous>6months of GC treatment. (3) In patients in whom GC discontinuation is not possible after 12months of treatment because of persistent disease activity or in patients in whom GC-related adverse events are unacceptable, TCZ (or alternatively methotrexate) may be proposed.ConclusionsThese recommendations were constructed based on the results of the published literature and the experts' experiences to standardise therapeutic practices in France. Further updates will likely be necessary following new publications.Copyright © 2024 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

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