Original scientific paper

https://doi.org/10.33004/reumatizam-67-2-6

TREATMENT OF GIANT CELL ARTERITIS USING TOCILIZUMAB

Daniel Victor Šimac orcid.org/0000-0003-3821-6969 ; Department of Rheumatology and Clinical Immunology, Clinical Hospital Center Rijeka, Rijeka, Croatia
Srđan Novak ; Department of Rheumatology and Clinical Immunology, Clinical Hospital Center Rijeka, Rijeka, Croatia

Abstract

Giant cell arteritis (GCA) or temporal arteritis (TA) is a large-vessel vasculitis of the elderly which, if untreated, can lead to blindness. Glucocorticoids (GCs) remain the main treatment, but high-dose and long-term use can lead to serious side effects. Tocilizumab (TCZ) is increasingly used as an alternative steroid-sparing treatment option with promising results. This case series presents three GCA patients with a refractory form and/or at high risk for side effects treated with TCZ due to diagnoses of glaucoma and osteoporosis. Two of the patients responded to the treatment with good results. All three patients are elderly females who initially presented with classic symptoms of headache and/ or vision loss. The first patient also presented with fever, and the second with jaw claudication. Both of them were treated with pulses of GCs, but since the first also had osteoporosis with vertebral fractures, and the second had glaucoma and remained on high doses, TCZ was introduced. Both patients have since been stable. After approximately five years, the third patient developed TA with rheumatic polymyalgia, which was successfully treated with GCs. Later on TCZ was introduced as GCs could not be discontinued in consideration of the presence of osteoporosis and glaucoma. TCZ was discontinued after the patient developed neutropenia. Our case series presents two successful cases of treating GCA patients with TCZ, solidifying the recommendations for TCZ as a viable option for refractory disease and patients at high risk for side effects.

Keywords

Giant cell arteritis – diagnosis, drug therapy; Temporal arteries – pathology; Glucocorticoids – adverse effects, therapeutic use; Antibodies, monoclonal, humanized – adverse effects, therapeutic use; Interleukin-6 – antagonists and inhibitors; Osteoporosis; Glaucoma

Hrčak ID:

262171

URI

https://hrcak.srce.hr/262171

Publication date:

14.9.2021.

Article data in other languages: croatian

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