Abstract
Purpose :
The GiACTA trial demonstrated the efficacy of tocilizumab (TCZ) in giant cell arteritis (GCA) [1]. However, the effectiveness of TCZ for prevention of specific GCA-related visual manifestations is currently unknown. The incidence of GCA-related visual manifestations was analyzed in patients treated with TCZ in a real-world setting.
Methods :
Retrospective analysis of GCA patients treated with TCZ at a single center (2010-2018). Disease flares were assessed among patients with and without visual impairment at diagnosis. Flares and new GCA-related visual manifestations including diplopia, transient blurred vision, amaurosis fugax and permanent vision loss due to anterior ischemic optic neuropathy (AION) or central retinal artery occlusion (CRAO) were assessed before and after TCZ initiation.
Results :
Of 60 GCA patients followed for a median (IQR) of 1.7 (0.7-2.9) years, 22 (36.6%) had visual impairment at diagnosis (AION/CRAO, n=8 [13.3%]; blurred vision, n=18 [30.0%]; amaurosis fugax, n=11 [18.3%]; diplopia, n=2 [3.3%]). On follow-up, 15 of 22 (68.2%) patients with and 28 of 38 (73.7%) without visual impairment at diagnosis had ≥1 disease flare. TCZ treatment was associated with significantly reduced incidence of flare and with longer time to flare (HR=0.22; 95% CI 0.10-0.50; P<0.001). Before TCZ initiation, new visual manifestations (AION, n=2; blurred vision, n=12; amaurosis fugax, n=4; diplopia, n=2) developed in 16/102 (15.7%) disease flares occurring in 43 of 60 (71.7%) patients. In contrast, after TCZ initiation, new visual manifestations (AION, n=0; blurred vision, n=3; amaurosis fugax, n=1; diplopia, n=0) developed in only 3/37 (8.1%) disease flares. Disease flares (18 of 60 patients [30%]) were less common following TCZ initiation.
Conclusions :
Similar incidence of disease flare was observed between GCA patients with or without baseline visual manifestations. TCZ treatment was associated with significantly reduced number of flares and decreased incidence of new visual manifestations. No permanent vision loss (e.g., AION) was observed after TCZ initiation.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.