Jonathan Kay, MD


December 18, 2015

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Hello, and welcome to my Medscape blog. I am Dr Jonathan Kay, professor of medicine and director of clinical research in the Division of Rheumatology at the University of Massachusetts Medical School and UMass Memorial Medical Center, both in Worcester.

I am here in San Francisco, attending the 2015 American College of Rheumatology annual scientific meeting, and I would like to share with you two very interesting presentations about giant cell arteritis, both of which were delivered as late-breaking abstracts yesterday.

Giant cell arteritis is a disease that we face infrequently, but that can have very serious consequences. If left untreated, patients with it can go blind, have strokes, and even die. Historically, we have treated this condition with corticosteroids—typically at high doses—and patients suffered the adverse effects of high-dose corticosteroid therapy: osteoporosis, avascular necrosis of bone, cataracts, glaucoma, cushingoid features, glucose intolerance, and many others.

There were two interesting presentations at the late-breaking abstract session about treatment of giant cell arteritis with biologic agents. One was an oral presentation[1] from Bern, Switzerland, which looked at tocilizumab therapy for these patients. They were treated with high-dose corticosteroids and tocilizumab, and then the corticosteroids were tapered according to a standardized regimen.

As the corticosteroids were tapered, there were fewer relapses in patients treated with tocilizumab compared with those treated with placebo, suggesting that tocilizumab is a very effective potential therapy for patients with giant cell arteritis. Treatment with tocilizumab also allows for sparing use of corticosteroids.

There was another late-breaking poster abstract, this one from Carol Langford and colleagues at the Cleveland Clinic[2] who looked at abatacept as a steroid-sparing agent. Like in the other presentation, patients with active giant cell arteritis were treated with abatacept, a T cell costimulation inhibitor, and corticosteroids with a standardized tapering regimen. The study showed statistically significant superiority of abatacept treatment in combination with corticosteroids compared with corticosteroids alone. It should be noted that although the findings were statistically significant, because the P value was 0.49, they were just barely statistically significant.

These two papers taken together suggest that we are now entering an era of biologic therapy, or potential biologic therapy, to spare the need for long-term, high-dose corticosteroids in patients with giant cell arteritis.

I look forward to seeing additional studies and larger studies of these agents, and others, in this potentially devastating disease.

Thank you for your attention. I look forward to seeing you again on Medscape.


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