The role of biologics in the treatment of giant cell arteritis

ABSTRACT

Introduction: Giant cell arteritis is a vasculitis of large and middle-sized arteries that affects individuals older than 50 years. Although glucocorticoids remain the mainstay in the treatment of this vasculitis, other drugs are often required to achieve clinical remission and allow glucocorticoid discontinuation.

Areas covered: The review summarizes the main biologic therapies used for the managements of GCA.

Expert commentary: Although several biologic agents have been used in patients with GCA, the only biologic agent currently approved for this purpose is the recombinant humanized anti-IL-6 receptor antibody: tocilizumab. It has demonstrated efficacy to improve clinical symptoms, decrease the cumulative prednisone dose and reduce the frequency of relapses in clinical trials and real-life studies on patients with GCA. A trial showed that abatacept may be useful to maintain remission in GCA patients. An open-label study suggested that ustekinumab could be useful for the treatment of patients with refractory GCA. However, further studies are required to confirm if both abatacept and ustekinumab are useful as an adjunctive therapy to reduce relapses or as a glucocorticoid‐sparing agent in GCA. Anakinra has been successfully used in a few patients with refractory GCA. In contrast, antitumor necrosis factor-α therapy yielded disappointing results in GCA.

Trial registration: ClinicalTrials.gov identifier: NCT02531633.

Trial registration: ClinicalTrials.gov identifier: NCT03600805.

Trial registration: ClinicalTrials.gov identifier: NCT02902731.

Trial registration: ClinicalTrials.gov identifier: NCT03026504.

KEYWORDS:

• Abatacept
• anti-IL6-receptor tocilizumab
• giant cell (temporal) arteritis
• methotrexate
• prednisone
• relapses

Article highlights

• IL-6 is a pivotal proinflammatory cytokine implicated in the pathogenesis of GCA.

• Glucocorticoids are the mainstay of treatment in GCA.

• Conventional immunosuppressive agents, such as MTX, are often used in relapsing GCA patients or as glucocorticoid sparing agents. However, its efficacy is often modest.

• The anti-IL-6 receptor monoclonal antibody-tocilizumab has proved efficacy in patients with GCA to reduce relapses and the cumulative prednisone dose.

• Tocilizumab is the only biologic agent currently approved for the management of GCA.

• The use of other biologic agents and JAK inhibitors for the management of GCA is currently under investigation.

Declaration of interest

MA Gonzalez-Gay has received grants/research supports from Abbvie, MSD, and Roche, and had consultation fees/participation in company sponsored speaker´s bureau from Abbvie, Pfizer, Roche, Sanofi, Sobi, Lilly, Novartis, and Celgene. R Blanco received grants/research supports from Abbvie, MSD, and Roche, and had consultation fees/participation in company sponsored speaker´s bureau from Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD. S Castañeda has received fees for lectures and honorary for participation in advisory boards from Abbvie, Amgen, Eli-Lilly, MSD, Pfizer, Roche, and Sobi. The authors have no other relevant affiliations or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.