BOSTON — New and emerging treatment strategies, including the anti-interleukin-6 agent tocilizumab, have established a “new era” of giant cell arteritis management, allowing rheumatologists and their patients to move on from the use of corticosteroids, according to a presentation here at the 2018 Interdisciplinary Autoimmune Summit.
“It is a better time to have giant cell arteritis, if you are going to have it,” Sebastian Unizony, MD, of Massachusetts General Hospital and Harvard Medical School, said during his presentation. “Why? Because we understand part of its physiology a little bit better. This has led to the first FDA-approved drug for giant cell arteritis (GCA), which is tocilizumab [Actemra, Genentech], as well as a bunch of trials that are ongoing and preliminary trials that are showing promising results.”
According to Unizony, these include abatacept (Orencia, Bristol-Myers Squibb) and ustekinumab (Stelara, Janssen), both of which have shown positive preliminary results, but still require confirmation in larger studies. In addition, there are several ongoing clinical trials, or studies currently in the design phase, analyzing the use of baricitinib (Olumiant, Eli Lilly) in the treatment of GCA.
Sebastian Unizony, MD, discusses emerging treatment strategies that have established a “new era” of giant cell arteritis management, allowing rheumatologists and their patients to move on from the use of corticosteroids.
Unizony stressed the importance of these developments, stating that, up until recently treatment for GCA was limited to corticosteroid therapy, which he described as “suboptimal. He noted that corticosteroid use resulted in toxicity in about 4 out of every 5 cases, with large-artery complications seen in approximately 30% of patients. In addition, disease flares are common, with 40% to 80% of patients with GCS treated with corticosteroids experiencing relapse.
According to research, interleukin-6 (IL-6) is up-regulated within inflamed arteries, and levels of IL-6 are elevated in the serum of GCA patients. Additionally, serum IL-6 levels correlate with GCA disease activity, Unizony said.
Findings from a 2017 phase-3 study of 250 patients with GCS, published in the New England Journal of Medicine, demonstrated that those treated with tocilizumab, compared to a placebo, experienced sustained, prednisone-free remission. In addition, the drug had a significant corticosteroid-sparing effect, and improved patient-reported quality of life.
“IL-6 blockers have proven to be a good option for many patients, although not all of the patients,” Unizony said. “The hope going forward is to completely get rid of the use of prednisone, with lots of good options in the pipeline that we can explore. Going forward, the question with IL-6 blockers is whether we can use it alone without steroids, and how long we should use it. That will come with more research.” – by Jason Laday
Unizony S. The Treatment of Giant Cell Arteritis in the Current Era: IL-6 Blockade and Other Treatment Strategies. Presented at: IAS 2018; April 27-29, 2018; Boston.
Disclosure: Unizony reports consulting fees from Galapagos, grant support from Janssen and Roche/Genentech and membership on the scientific advisory board for GlaxoSmithKline and Sanofi.