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Tocilizumab Vs Methotrexate in a Cohort of Patients Affected by Active GCA: A Comparative Clinical and Ultrasonographic Study

INTRODUCTION: No head-to-head study has assessed the superiority of tocilizumab versus methotrexate in giant cell arteritis (GCA), and few studies have demonstrated its effectiveness in terms of ultrasonographic findings, but without a control group. The primary endpoint was to assess whether tocili...

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Autores principales: Grazzini, Silvia, Conticini, Edoardo, Falsetti, Paolo, D’Alessandro, Miriana, Sota, Jurgen, Terribili, Riccardo, Baldi, Caterina, Fabiani, Claudia, Bargagli, Elena, Cantarini, Luca, Frediani, Bruno
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697083/
http://dx.doi.org/10.2147/BTT.S431818
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author Grazzini, Silvia
Conticini, Edoardo
Falsetti, Paolo
D’Alessandro, Miriana
Sota, Jurgen
Terribili, Riccardo
Baldi, Caterina
Fabiani, Claudia
Bargagli, Elena
Cantarini, Luca
Frediani, Bruno
author_facet Grazzini, Silvia
Conticini, Edoardo
Falsetti, Paolo
D’Alessandro, Miriana
Sota, Jurgen
Terribili, Riccardo
Baldi, Caterina
Fabiani, Claudia
Bargagli, Elena
Cantarini, Luca
Frediani, Bruno
author_sort Grazzini, Silvia
collection PubMed
description INTRODUCTION: No head-to-head study has assessed the superiority of tocilizumab versus methotrexate in giant cell arteritis (GCA), and few studies have demonstrated its effectiveness in terms of ultrasonographic findings, but without a control group. The primary endpoint was to assess whether tocilizumab was superior to methotrexate in inducing normalization of US findings, whereas the secondary endpoint was to assess the effectiveness of precocious withdrawal of glucocorticoids. METHODS: We prospectively enrolled all the patients with active GCA at our clinic. The inclusion criteria were clinical diagnosis of GCA; active disease; and clinical, laboratory, and US data, evaluated using the halo count (HC) and OMERACT GCA Ultrasonography Score (OGUS). Evaluations were repeated at 3, 6, and 12 months. RESULTS: Twenty patients were treated with Tocilizumab and 9 with Methotrexate. All but three tocilizumab-treated patients achieved remission at six months, whereas at 12 months, all patients were in glucocorticoid-free remission. Up to three of the nine methotrexate patients experienced a lack of efficacy or minor relapses. Tocilizumab-treated patients showed a statistically significant difference between baseline and all follow-ups in terms of OGUS and HC, whereas the difference in the Methotrexate group was significant after 1 year. The mean glucocorticoid dosage significantly decreased in both groups. No severe adverse events or major relapses were reported. CONCLUSION: Our study demonstrates the superiority in terms of rapidity of a tocilizumab-based scheme over a methotrexate-based scheme in inducing clinical and US remission. Precocious withdrawal of glucocorticoids did not increase the risk of relapse.
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spelling pubmed-106970832023-12-06 Tocilizumab Vs Methotrexate in a Cohort of Patients Affected by Active GCA: A Comparative Clinical and Ultrasonographic Study Grazzini, Silvia Conticini, Edoardo Falsetti, Paolo D’Alessandro, Miriana Sota, Jurgen Terribili, Riccardo Baldi, Caterina Fabiani, Claudia Bargagli, Elena Cantarini, Luca Frediani, Bruno Biologics Original Research INTRODUCTION: No head-to-head study has assessed the superiority of tocilizumab versus methotrexate in giant cell arteritis (GCA), and few studies have demonstrated its effectiveness in terms of ultrasonographic findings, but without a control group. The primary endpoint was to assess whether tocilizumab was superior to methotrexate in inducing normalization of US findings, whereas the secondary endpoint was to assess the effectiveness of precocious withdrawal of glucocorticoids. METHODS: We prospectively enrolled all the patients with active GCA at our clinic. The inclusion criteria were clinical diagnosis of GCA; active disease; and clinical, laboratory, and US data, evaluated using the halo count (HC) and OMERACT GCA Ultrasonography Score (OGUS). Evaluations were repeated at 3, 6, and 12 months. RESULTS: Twenty patients were treated with Tocilizumab and 9 with Methotrexate. All but three tocilizumab-treated patients achieved remission at six months, whereas at 12 months, all patients were in glucocorticoid-free remission. Up to three of the nine methotrexate patients experienced a lack of efficacy or minor relapses. Tocilizumab-treated patients showed a statistically significant difference between baseline and all follow-ups in terms of OGUS and HC, whereas the difference in the Methotrexate group was significant after 1 year. The mean glucocorticoid dosage significantly decreased in both groups. No severe adverse events or major relapses were reported. CONCLUSION: Our study demonstrates the superiority in terms of rapidity of a tocilizumab-based scheme over a methotrexate-based scheme in inducing clinical and US remission. Precocious withdrawal of glucocorticoids did not increase the risk of relapse. Dove 2023-12-01 /pmc/articles/PMC10697083/ http://dx.doi.org/10.2147/BTT.S431818 Text en © 2023 Grazzini et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Grazzini, Silvia
Conticini, Edoardo
Falsetti, Paolo
D’Alessandro, Miriana
Sota, Jurgen
Terribili, Riccardo
Baldi, Caterina
Fabiani, Claudia
Bargagli, Elena
Cantarini, Luca
Frediani, Bruno
Tocilizumab Vs Methotrexate in a Cohort of Patients Affected by Active GCA: A Comparative Clinical and Ultrasonographic Study
title Tocilizumab Vs Methotrexate in a Cohort of Patients Affected by Active GCA: A Comparative Clinical and Ultrasonographic Study
title_full Tocilizumab Vs Methotrexate in a Cohort of Patients Affected by Active GCA: A Comparative Clinical and Ultrasonographic Study
title_fullStr Tocilizumab Vs Methotrexate in a Cohort of Patients Affected by Active GCA: A Comparative Clinical and Ultrasonographic Study
title_full_unstemmed Tocilizumab Vs Methotrexate in a Cohort of Patients Affected by Active GCA: A Comparative Clinical and Ultrasonographic Study
title_short Tocilizumab Vs Methotrexate in a Cohort of Patients Affected by Active GCA: A Comparative Clinical and Ultrasonographic Study
title_sort tocilizumab vs methotrexate in a cohort of patients affected by active gca: a comparative clinical and ultrasonographic study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697083/
http://dx.doi.org/10.2147/BTT.S431818
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