Abstract：
OBJECTIVE: Aortitis in Giant Cell Arteritis (GCA-aortitis) is a frequent complication that may lead to aneurysms. Tocilizumab (TCZ) was approved in GCA, but the efficacy in GCA-aortitis and aneurysms has not been analyzed to date. Our aim was to assess the effectiveness and safety of TCZ in a wide series of GCA-aortitis and aneurysms.
METHODS: Multicentre observational study with GCA-aortitis treated with TCZ. GCA was diagnosed by: a) ACR criteria, b) temporal artery biopsy, and/or c) imaging techniques. Aortitis was diagnosed mainly by PET/CT. Main outcomes were EULAR and imaging remission. Others were clinical remission, analytical normalization, corticosteroid-sparing effect, and the prevention and improvement of aneurysms.
RESULTS: 196 patients with GCA-aortitis treated with TCZ. After 6 months, 72.2% reached EULAR remission but only 12% an imaging remission; increasing up-to 81.4% and 31.8%, respectively, at 24 months. A rapid clinical remission, ESR and CRP normalization was observed in 47.4%, 84.3% and 55.6%, at 1 month, increasing to 89.6%, 85.3% and 80.3% at 24 months, respectively. Aneurysms were present in 10 (5%) patients. Five of them required early surgery, while 3 others enlarged. No patient on TCZ therapy developed aneurysms during follow-up.
CONCLUSIONS: In patients with GCA-aortitis treated with TCZ, a rapid and maintained clinical and analytical improvement was observed. However, there was an uncoupling between clinical and EULAR remission with imaging remission.
METHODS: Multicentre observational study with GCA-aortitis treated with TCZ. GCA was diagnosed by: a) ACR criteria, b) temporal artery biopsy, and/or c) imaging techniques. Aortitis was diagnosed mainly by PET/CT. Main outcomes were EULAR and imaging remission. Others were clinical remission, analytical normalization, corticosteroid-sparing effect, and the prevention and improvement of aneurysms.
RESULTS: 196 patients with GCA-aortitis treated with TCZ. After 6 months, 72.2% reached EULAR remission but only 12% an imaging remission; increasing up-to 81.4% and 31.8%, respectively, at 24 months. A rapid clinical remission, ESR and CRP normalization was observed in 47.4%, 84.3% and 55.6%, at 1 month, increasing to 89.6%, 85.3% and 80.3% at 24 months, respectively. Aneurysms were present in 10 (5%) patients. Five of them required early surgery, while 3 others enlarged. No patient on TCZ therapy developed aneurysms during follow-up.
CONCLUSIONS: In patients with GCA-aortitis treated with TCZ, a rapid and maintained clinical and analytical improvement was observed. However, there was an uncoupling between clinical and EULAR remission with imaging remission.
摘要：
目的：巨细胞动脉炎（GCA-主动脉炎）的主动脉炎是一种常见的并发症，可能导致动脉瘤。Tocilizumab（TCZ）在GCA中获得批准，但迄今为止尚未对GCA-主动脉炎和动脉瘤的疗效进行分析.我们的目的是评估TCZ在一系列GCA主动脉炎和动脉瘤中的有效性和安全性。
方法：使用TCZ治疗GCA-主动脉炎的多中心观察性研究。GCA诊断为：a)ACR标准，b)颞动脉活检,和/或c)成像技术。主动脉炎主要通过PET/CT诊断。主要结果为EULAR和影像学缓解。其他人是临床缓解，分析标准化，保留皮质类固醇的作用，以及动脉瘤的预防和改善。
结果：196例GCA主动脉炎患者接受TCZ治疗。六个月后,72.2％达到EULAR缓解，但只有12％的影像学缓解；增加高达81.4％和31.8％，分别,在24个月。快速临床缓解，观察到ESR和CRP正常化在47.4%,84.3%和55.6%，在1个月，增加到89.6%，24个月时分别为85.3%和80.3%，分别。10例（5％）患者存在动脉瘤。其中五人需要早期手术，另外3个扩大了。在随访期间，没有接受TCZ治疗的患者出现动脉瘤。
结论：在接受TCZ治疗的GCA主动脉炎患者中，观察到快速且持续的临床和分析改善.然而,临床缓解和EULAR缓解与影像学缓解之间存在解耦.
方法：使用TCZ治疗GCA-主动脉炎的多中心观察性研究。GCA诊断为：a)ACR标准，b)颞动脉活检,和/或c)成像技术。主动脉炎主要通过PET/CT诊断。主要结果为EULAR和影像学缓解。其他人是临床缓解，分析标准化，保留皮质类固醇的作用，以及动脉瘤的预防和改善。
结果：196例GCA主动脉炎患者接受TCZ治疗。六个月后,72.2％达到EULAR缓解，但只有12％的影像学缓解；增加高达81.4％和31.8％，分别,在24个月。快速临床缓解，观察到ESR和CRP正常化在47.4%,84.3%和55.6%，在1个月，增加到89.6%，24个月时分别为85.3%和80.3%，分别。10例（5％）患者存在动脉瘤。其中五人需要早期手术，另外3个扩大了。在随访期间，没有接受TCZ治疗的患者出现动脉瘤。
结论：在接受TCZ治疗的GCA主动脉炎患者中，观察到快速且持续的临床和分析改善.然而,临床缓解和EULAR缓解与影像学缓解之间存在解耦.
