Giant cell arteritis (GCA)–related aortitis represents a serious and potentially life-threatening manifestation of the disease, with risks including aortic aneurysm formation and dissection. Tocilizumab, an interleukin-6 receptor inhibitor, has emerged as an effective treatment option for GCA and is approved for use via both intravenous and subcutaneous routes. While landmark trials have established its overall efficacy, they did not specifically focus on patients with aortic involvement, and direct comparisons between administration routes in this subgroup have been lacking.
To address this gap, Carmen Secada-Gómez, MD, from the Department of Rheumatology at Hospital Universitario Marqués de Valdecilla in Santander, Spain, and colleagues conducted a multicenter observational study evaluating the effectiveness of IV versus SC tocilizumab in routine clinical practice. The study included 196 patients with imaging-confirmed GCA-associated aortitis who were treated with tocilizumab across multiple centers.
Participants were predominantly women (148 patients), with a mean age of 69.8 years. GCA was diagnosed using standard criteria, including the 1990 American College of Rheumatology classification, temporal artery biopsy, and/or vascular imaging. Aortitis was confirmed using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). Patients were grouped based on the route of tocilizumab administration, with 110 receiving IV therapy and 86 treated with the SC formulation.
Baseline demographic characteristics, clinical features, and inflammatory markers were similar between the two groups, allowing for a balanced comparison. Over a follow-up period of up to 24 months, several outcomes were assessed, including EULAR-defined remission, clinical remission, imaging remission, resolution of systemic inflammation, and the glucocorticoid-sparing effect.
The key findings were as follows:
• EULAR-defined remission was achieved more often with subcutaneous tocilizumab than with intravenous administration (83.3% vs 80.6%), with the difference reaching statistical significance.
• No significant differences were observed between subcutaneous and intravenous tocilizumab in terms of imaging remission on PET/CT.
• Rates of normalization of systemic inflammatory markers were comparable between the two treatment groups.
• Both administration routes showed a similar glucocorticoid-sparing effect.
• Comparable imaging outcomes indicate that vascular inflammation responds similarly regardless of the route of tocilizumab delivery.
According to the investigators, the study's strengths include its multicenter design and relatively large sample size for a rare but severe GCA manifestation. However, as an observational study, it may be subject to residual confounding.
"Overall, the findings suggest that while subcutaneous tocilizumab may offer a slight advantage in achieving clinical remission, both SC and IV formulations provide comparable control of vascular inflammation in GCA-associated aortitis, supporting flexibility in treatment decisions based on patient preference and clinical context," the authors concluded.
Reference:
Secada-Gómez, C., Loricera, J., Gutiérrez, M., Narváez, J., Aldasoro, V., Maiz, O., Vela, P., Romero-Yuste, S., Galíndez-Agirregoikoa, E., Fernandez-López, J. C., Ferraz-Amaro, I., Sanchez-Martín, J., Moya, P., Campos, C., Castañeda, S., & Blanco, R. SUBCUTANEOUS VERSUS INTRAVENOUS TOCILIZUMAB IN AORTITIS ASSOCIATED WITH GIANT CELL ARTERITIS: MULTICENTER STUDY OF 196 PATIENTS. Arthritis Care & Research. https://doi.org/10.1002/acr.80006
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