P184 Developing a pathway for tocilizumab treatment in giant cell arteritis: a South London regional experience

Abstract Background Tocilizumab is now approved by the National Institute of Health and Care Excellence (NICE) for up to a year in relapsing or refractory giant cell arteritis (GCA). The practicalities of developing a pathway for referral using a hub and spoke model were previously unknown. Here we discuss our novel experiences utilising tocilizumab for GCA in its first year of licensing, after the introduction of a new regional multi-disciplinary team referral pathway. Methods We assessed all patients started on tocilizumab for GCA between August 2018-May 2019. The central assessing hub is St George’s University Hospitals NHS Foundation Trust, a large tertiary rheumatology department in the South of England, serving a population of 1.3 million. Results As per Table 1 below. A total of 9 patients were identified: 6 female and 3 male, with an average age of 74.2 (range 63-80). 5 patients were referred internally from clinicians at St George’s Hospital, with the remainder from local district general hospitals. Steroid protocols between patients were varied, and two-thirds required a 3-day IV methylprednisolone course, including all 4 patients with visual symptoms. A third of patients were on concurrent methotrexate, a disease-modifying antirheumatic drug. 8 of 9 patients were on alendronate, vitamin D/calcium, and a gastroprotective agent, and 7 were on aspirin. Reported side effects from steroids were common, with weight gain, increased appetite and osteoporosis noted. All our 9 patients continue their tocilizumab injections, with one individual having a 3-month break for a routine hip operation, and another a 1-month hiatus due to temporary derangement in liver function tests. Tocilizumab proffered improved disease control and few side effects were noted. 3 patients have now been on tocilizumab for 12 months and raise interesting discussions about ongoing funding and treatment efficacy. Conclusion Our case series shows the development and delivery of an effective hub and spoke referral pathway for tocilizumab treatment in GCA. We show that steroid dosing could be reduced with tocilizumab, and that all subjects received full funding for treatment. Our referral pathway has encouraged the uptake of the IL-6 monoclonal antibody treatment for GCA and compliance with NICE guidelines. Disclosures P. Saha None. V. Sandhu None. H. Robinson None. A. Ezeonyeji None. I. Al-Shakarchi None. S. Chander None. R. Suresh None. A. Kaul None. N. Sofat None.

Download Full-text

Tocilizumab in Giant Cell Arteritis: A Multicenter Retrospective Study of 34 Patients

The Journal of Rheumatology ◽

10.3899/jrheum.151252 ◽

2016 ◽

Vol 43 (8) ◽

pp. 1547-1552 ◽

Cited By ~ 33

Author(s):

Alexis Régent ◽

Serge Redeker ◽

Alban Deroux ◽

Pierre Kieffer ◽

Kim Heang Ly ◽

...

Keyword(s):

Retrospective Study ◽

Side Effects ◽

Adverse Events ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Multicenter Study ◽

Efficacy And Safety ◽

Severe Adverse Events ◽

Retrospective Multicenter Study

Objective.To report the efficacy and safety of tocilizumab (TCZ) for giant cell arteritis (GCA).Methods.A retrospective multicenter study that included 34 patients receiving TCZ for GCA.Results.TCZ was effective in all but 6 patients, who still had mild symptoms. Mean glucocorticoid dose was tapered. One patient died and 3 patients had to stop TCZ therapy because of severe adverse events. Twenty-three patients stopped treatment; 8 of these experienced relapses after a mean of 3.5 ± 1.3 months.Conclusion.TCZ is effective in GCA. However, side effects occur. Whether this treatment has only a suspensive effect remains to be determined.

Download Full-text

Leflunomide as a corticosteroid-sparing agent in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR): A consecutive case series

La Presse Médicale ◽

10.1016/j.lpm.2013.02.177 ◽

2013 ◽

Vol 42 (4) ◽

pp. 726-727

Author(s):

H. Hetland ◽

G. Myklebust ◽

A.P. Diamantopoulos

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Polymyalgia Rheumatica ◽

Case Series ◽

Consecutive Case

Download Full-text

Is there a place for cyclophosphamide in the treatment of giant-cell arteritis? A case series and systematic review

Seminars in Arthritis and Rheumatism ◽

10.1016/j.semarthrit.2012.12.023 ◽

2013 ◽

Vol 43 (1) ◽

pp. 105-112 ◽

Cited By ~ 48

Author(s):

Hubert de Boysson ◽

Jonathan Boutemy ◽

Christian Creveuil ◽

Yann Ollivier ◽

Philippe Letellier ◽

...

Keyword(s):

Systematic Review ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Case Series

Download Full-text

SAT0230 GIANT CELL ARTERITIS WITH INTRACRANIAL VASCULITIS: A CASE SERIES

10.1136/annrheumdis-2019-eular.3548 ◽

2019 ◽

Author(s):

Alexander Hawkins ◽

Catalina Sanchez Alvarez ◽

Matthew Koster ◽

Cynthia S. Crowson ◽

Kenneth J. Warrington

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Case Series

Download Full-text

Sudden sensorineural hearing loss: when is it idiopathic?

The Journal of Laryngology & Otology ◽

10.1017/s0022215109992064 ◽

2010 ◽

Vol 124 (6) ◽

pp. 690-693 ◽

Cited By ~ 6

Author(s):

H Wilson ◽

D J Alderson

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Preliminary Investigation ◽

Liver Function Tests ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Relative Uncertainty ◽

The Right

AbstractObjective: To highlight the importance of assessing the certainty of a diagnosis of idiopathic sudden sensorineural hearing loss, and of modifying patient management accordingly.Case report: A patient presented with sudden sensorineural hearing loss in the right ear. Following assessment and preliminary investigation, a diagnosis of idiopathic sudden sensorineural hearing loss was made. Steroid treatment was commenced. Two weeks later, the patient experienced sudden sensorineural hearing loss in the left ear, and scalp tenderness. Subsequent biopsy confirmed giant cell arteritis.Conclusions: Management of idiopathic sudden sensorineural hearing loss should be guided by the level of certainty of diagnosis. If there is relative uncertainty, risk factors for specific diagnoses should be sought, the patient should be followed more closely, and investigation should be tailored appropriately. Giant cell arteritis should be considered in patients older than 50 years, those exhibiting suggestive signs or symptoms, and those with elevated inflammatory markers or deranged liver function tests.

Download Full-text

EP03 An audit of glucocorticoid prescription in patients with giant cell arteritis

Rheumatology ◽

10.1093/rheumatology/keaa109.002 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Hairul Hadi Ariff ◽

Abid Awisat ◽

Jack Arnold ◽

Hudaifa Al Ani ◽

Lorraine O' Neill ◽

...

Keyword(s):

Side Effects ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Significant Variation ◽

Medical Advice ◽

High Dose ◽

Daily Number ◽

Daily Dose ◽

Duration Of Disease ◽

The Mean

Abstract Background Giant cell arteritis (GCA) is treated with high dose glucocorticoids and progressively reduced over months to years. We undertook an audit to evaluate self-reported adherence to the original recommended glucocorticoid course and explored reasons for any variation. Methods We recruited patients attending a single rheumatology department over 18 months. Respondents were given two self-administered questionnaires to record information regarding their use of glucocorticoids during the last 7 days and during the last 6 months. We retrieved 132 questionnaires (of whom 6 were discarded as incomplete). All data was analysed using SPSS Statistics v22. Results Of the 126 patients (mean age 74.9 ± 7.7 years), 59% were female. The mean duration of disease was 22.5 ± 19.1 months in patients with GCA and 32.9 ± 29.9 months in those with GCA and polymyalgia rheumatica (PMR). The mean daily number of medications taken was 9.2 ± 5.2 (range: 1 - 30); the mean number of types of daily tablets taken was 5.0 ± 2.1 (range: 1 - 10). The mean daily number of glucocorticoid tablets taken was 3.2 ± 2.6 (range: 0 - 12), with a mean daily dose of 11.1 ± 10.3 mg (range: 0 - 60 mg). Overall, in the last 7 days, 22% and in last 6 months, 40% of patients were not following their original recommended steroid regimens (Table 1). The total mean glucocorticoid dose in the last 7 days group (n = 81) was 77.8 ± 70.1 mg/week (11.1 ± 10.1 mg/day) whilst the total mean glucocorticoid dose in the last 6 months group (n = 45) was 1782.0 ± 1543.3 mg/6 month (9.9 ± 8.6 mg/day). Most respondents stated their glucocorticoid non-adherence was due to medical advice; other reasons included forgetting, fear of side effects, or confusion about different preparations of prescribed glucocorticoids. The presence of PMR did not influence glucocorticoid adherence. Conclusion There is significant variation in the use of glucocorticoids compared to the original starting regimen in patients with GCA, with or without PMR. However, the amount of the discrepancy is small. The commonest reason for non-adherence was medical advice received from either primary or secondary care. Disclosures H. Ariff: None. A. Awisat: None. J. Arnold: None. H. Al ani: None. L. O' neill: None. M. Rodriguez: None. R. Luqmani: None.

Download Full-text

ENLIVEN study: Pexidartinib for tenosynovial giant cell tumor (TGCT)

Future Oncology ◽

10.2217/fon-2020-0307 ◽

2020 ◽

Vol 16 (25) ◽

pp. 1875-1878 ◽

Cited By ~ 1

Author(s):

William Tap

Keyword(s):

Side Effects ◽

Giant Cell Tumor ◽

Giant Cell ◽

Liver Function Tests ◽

Tendon Sheath ◽

Cell Tumor ◽

Hair Color ◽

Plain Language ◽

Clinical Trial Registration ◽

Tenosynovial Giant Cell Tumor

Pexidartinib is the first approved medication in the USA for people with tenosynovial giant cell tumor (TGCT). The drug was approved based on the ENLIVEN study, which looked at pexidartinib (brand name, Turalio™), a medication taken by mouth (orally) for people with TGCT (also known as giant cell tumor of the tendon sheath [GCTTS] and pigmented villonodular synovitis [PVNS]) who are not able to have surgery because of the location and/or the size of the tumor. The study showed that pexidartinib is effective in treating people with TGCT because it shrunk the size of their tumors and improved their symptoms and their ability to function. In general, people treated with pexidartinib had side effects that were mostly mild that went away after treatment with pexidartinib was stopped. The most common side effects were hair color changes and tiredness (fatigue). Pexidartinib was also associated with liver problems (or hepatotoxicity), which started within the first 2 months of treatment. Due to the risk of liver problems, which may be severe and potentially life threatening, the researchers closely monitored participants’ blood liver function tests before, during, and after participants in the study took pexidartinib. To read the full Plain Language Summary of this article, click on the View Article button above and download the PDF. Clinical Trial Registration: NCT02371369 ( ClinicalTrials.gov )

Download Full-text

FRI0333 Leflunomide as a corticosteroid-sparing agent in giant cell arteritis and polymyalgia rheumatica: a consecutive case series

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2013-eular.1460 ◽

2013 ◽

Vol 72 (Suppl 3) ◽

pp. A487.1-A487

Author(s):

H. Hetland ◽

G. Myklebust ◽

A. P. Diamantopoulos

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Polymyalgia Rheumatica ◽

Case Series ◽

Consecutive Case

Download Full-text

What is the impact of giant cell arteritis on patients’ lives? A UK qualitative study

BMJ Open ◽

10.1136/bmjopen-2017-017073 ◽

2017 ◽

Vol 7 (8) ◽

pp. e017073 ◽

Cited By ~ 8

Author(s):

Jennifer Liddle ◽

Roisin Bartlam ◽

Christian D Mallen ◽

Sarah L Mackie ◽

James A Prior ◽

...

Keyword(s):

Side Effects ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Thematic Analysis ◽

Treatment Goals ◽

Telephone Interviews ◽

Everyday Lives ◽

Future Loss ◽

The Impact ◽

Inductive Thematic Analysis

ObjectivesClinical management of giant cell arteritis (GCA) involves balancing the risks and burdens arising from the disease with those arising from treatment, but there is little research on the nature of those burdens. We aimed to explore the impact of giant cell arteritis (GCA) and its treatment on patients’ lives.MethodsUK patients with GCA participated in semi-structured telephone interviews. Inductive thematic analysis was employed.Results24 participants were recruited (age: 65–92 years, time since diagnosis: 2 months to >6 years). The overarching themes from analysis were: ongoing symptoms of the disease and its treatment; and ‘life-changing’ impacts. The overall impact of GCA on patients’ lives arose from a changing combination of symptoms, side effects, adaptations to everyday life and impacts on sense of normality. Important factors contributing to loss of normality were glucocorticoid-related treatment burdens and fear about possible future loss of vision.ConclusionsThe impact of GCA in patients’ everyday lives can be substantial, multifaceted and ongoing despite apparent control of disease activity. The findings of this study will help doctors better understand patient priorities, legitimise patients’ experiences of GCA and work with patients to set realistic treatment goals and plan adaptations to their everyday lives.

Download Full-text