Vision loss in patients with giant cell arteritis treated with tocilizumab

Jennifer Amsler,Godehard Scholz,Lisa Christ,Odile Stalder,Luca Seitz,Christoph Tappeiner,Stephan Reichenbach,Peter M Villiger,Florian Kollert,Iveta Kysela

doi:10.1186/s13075-021-02480-4

Jennifer Amsler, Godehard Scholz + Show 8 more

Open Access

https://doi.org/10.1186/s13075-021-02480-4

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Abstract

ObjectivesGiant cell arteritis (GCA) may lead to vision loss. To what extent tocilizumab (TCZ) is able to prevent vision loss is unknown. The aim was to analyze the occurrence of vision loss in a large GCA cohort treated with TCZ.MethodsIn this observational monocentric study, GCA patients treated with TCZ between the years 2010 and 2018 were studied. Demographic, clinical, and laboratory data were analyzed.ResultsA total of 186 patients were included (62% female); 109 (59%) fulfilled the American College of Rheumatology (ACR) criteria, in 123 (66%) patients, large vessel vasculitis was diagnosed by magnetic resonance-angiography (MRA). Cumulative duration of TCZ treatment was 224 years, median treatment duration was 11.1 (IQR 5.6–17.9) months. Glucocorticoids (GC) were tapered over a median of 5.8 (IQR 3.0–8.5) months. At baseline, visual symptoms were present in 70 (38%) and vision loss in 21 (11%) patients. Patients with vision loss at baseline were older (p = 0.032), had a lower C-reactive protein (p = 0.002), and showed a negative association with MRA of the aorta (p = 0.006). Two patients (1.1%) developed vision loss, both at the initiation of TCZ treatment.ConclusionOur data show a very low incidence of vision loss in TCZ-treated patient. The two cases of AION occurred at the initiation of therapy, they support the hypothesis that advanced, and established structural changes of arteries are key factors for this accident. Whether a shorter duration of concomitant GC treatment is risky regarding vision loss needs to be studied.

Highlights

Giant cell arteritis (GCA) is the most common vasculitis in Western populations at older age [1, 2]
The patients fulfilled the criteria for GCA as defined in the two previously published randomized controlled trials (RCTs) [12, 13], i.e., patients either fulfilled the American College of Rheumatology (ACR) criteria of GCA and/or they suffered from symptoms of polymyalgia rheumatica (PMR) plus large vessel vasculitis (LVV) as diagnosed by magnetic resonance angiography (MRA)
Patient characteristics A total of 186 patients diagnosed with GCA were treated with GC and TCZ according to published RCTs [12, 13], i.e., treatment was started with prednisone (PDN) at a dose of 1 mg/kg body weight per day or three pulses of intravenous corticosteroid treatment depending of the ocular involvement followed by 1 mg/kg body weight of PDN

Summary

Introduction

Giant cell arteritis (GCA) is the most common vasculitis in Western populations at older age [1, 2]. Glucocorticoids (GC) are prescribed immediately [4]. The rate of vision loss in patients with GCA seems to have decreased over the last decades, probably due to earlier diagnosis of GCA and prompt start of GC treatment [5]. A recent retrospective study showed a prevalence of 2% of vision loss in 840 biopsyproven GCA compared to the reference population of Skane (Sweden) with a prevalence of 0.6% [6]. Further studies have documented vision loss mainly due to AION during treatment with GC at a variable rate between 0.7 to 10% [7,8,9,10]

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