治疗巨细胞动脉炎的 Tocilizumab:复发和因不良反应停用妥昔单抗后的临床结果

IF 3.6 2区 医学 Q2 RHEUMATOLOGY Journal of Rheumatology Pub Date : 2024-11-15 DOI:10.3899/jrheum.2024-0612
Fumika N Nagase, Sho Fukui, Naoho Takizawa, Toshihiro Yamaguchi, Nobuhiro Oda, Hajime Inokuchi, Takanori Ito, Mitsuru Watanabe, Masei Suda, Yochiro Haji, Yasuhiro Suyama, Ryo Rokutanda, Masahiro Minoda, Atsushi Nomura, Eishi Uechi, Hiromichi Tamaki
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引用次数: 0

摘要

目的:托西珠单抗(TCZ)对巨细胞动脉炎(GCA)有效。然而,人们对GCA复发或因不良事件(AEs)而停用TCZ等不利事件发生后的治疗调整和临床结果知之甚少:这项多中心回顾性研究纳入了 2008 年至 2021 年期间在日本五家医院接受 TCZ 治疗的 GCA 患者。在开始使用TCZ后的两年内,对GCA复发和与TCZ相关的AEs进行了监测。对 GCA 复发患者的后续临床过程(包括复发症状和治疗调整)进行了为期 90 天的随访。同样,对因AEs而停用TCZ的患者也进行了额外的随访,直至TCZ停用一年后,以评估AEs、复发和治疗变化:在62名符合条件的患者中,有10名患者(16%)在开始接受TCZ治疗后复发。大多数复发(8/10)发生在延长TCZ治疗间隔或停用TCZ后。调整TCZ间隔、糖皮质激素(GC)和/或甲氨蝶呤(MTX)的组合可控制复发,且无严重并发症。在整个队列中,28 名患者(45%)出现了 AE,8 名患者(13%)因 AE 而停用 TCZ。在出现与 AE 相关的 TCZ 停药后,6 名患者试图在不使用其他免疫抑制剂的情况下减量 GC,其中 4 人随后复发。与此相反,有两名患者在使用其他免疫抑制剂或生物疗法后减少了GC的用量,但没有复发:结论:虽然GCA在开始TCZ治疗后可能复发,但大多数复发可以通过调整TCZ、GC和/或MTX得到安全控制。当患者因AEs停用TCZ时,添加免疫抑制剂或生物治疗可能与预防复发有关。
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Tocilizumab for Giant Cell Arteritis: Clinical Outcomes Following Relapses and Tocilizumab Discontinuation Due to Adverse Events.

Objective: Tocilizumab (TCZ) is effective for giant cell arteritis (GCA). However, little is known regarding treatment modification and clinical outcomes after unfavorable events, such as GCA relapses or TCZ discontinuation due to adverse events (AEs).

Methods: This multicenter retrospective study included GCA patients who initiated TCZ from 2008 to 2021 at five Japanese hospitals. GCA relapses and TCZ-related AEs were monitored for two years after TCZ initiation. In patients with GCA relapses, subsequent clinical courses, including relapse symptoms and treatment modification, were followed for 90 days after the relapses. Similarly, patients who discontinued TCZ due to AEs were additionally followed until one year after the TCZ discontinuation to evaluate AEs, relapses, and treatment changes.

Results: Of 62 eligible patients, 10 patients (16%) relapsed after initiating TCZ therapy. Most relapses (8/10) occurred after extending TCZ intervals or discontinuing TCZ. Combinations of adjusting TCZ intervals, glucocorticoid (GC), and/or methotrexate (MTX) could manage the relapses without serious complications. In the entire cohort, AEs occurred in 28 patients (45%), and 8 patients (13%) discontinued TCZ due to AEs. After AE-related TCZ discontinuation, six patients attempted to taper GC without other immunosuppressive treatments, and four subsequently relapsed. In contrast, two patients who used other immunosuppressants or biological therapy could decrease GC without relapses.

Conclusion: Although GCA relapses can occur after initiating TCZ therapy, most relapses can be safely managed by adjusting TCZ, GC, and/or MTX. Adding immunosuppressants or biological treatments may potentially be related to preventing relapses when patients discontinue TCZ due to AEs.

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来源期刊
Journal of Rheumatology
Journal of Rheumatology 医学-风湿病学
CiteScore
6.50
自引率
5.10%
发文量
285
审稿时长
1 months
期刊介绍: The Journal of Rheumatology is a monthly international serial edited by Earl D. Silverman. The Journal features research articles on clinical subjects from scientists working in rheumatology and related fields, as well as proceedings of meetings as supplements to regular issues. Highlights of our 41 years serving Rheumatology include: groundbreaking and provocative editorials such as "Inverting the Pyramid," renowned Pediatric Rheumatology, proceedings of OMERACT and the Canadian Rheumatology Association, Cochrane Musculoskeletal Reviews, and supplements on emerging therapies.
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