Patients’ Baseline Characteristics, but Not Tocilizumab Exposure, Affect Severe Outcomes Onset in Giant Cell Arteritis: A Real-World Study

Cyril Dumain (1, 2) , Jonathan Broner (1, 2) , Erik Arnaud (1, 2) , Emmanuel Dewavrin (3) , Jan Holubar (1) , Myriam Fantone (1, 2) , Benoit De Wazières (1, 2) , Simon Parreau (4, 5) , Pierre Fesler (6, 3) , Philippe Guilpain (7, 3) , Camille Roubille (6, 3) , Radjiv Goulabchand (7, 1)

1 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
2 UM - Université de Montpellier
3 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
4 UNILIM - Université de Limoges
5 CHU Limoges
6 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
7 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)

Objectives: Giant cell arteritis (GCA) is associated with severe outcomes such as infections and cardiovascular diseases. We describe here the impact of GCA patients’ characteristics and treatment exposure on the occurrence of severe outcomes. Methods: Data were collected retrospectively from real-world GCA patients with a minimum of six-months follow-up. We recorded severe outcomes and treatment exposure. In the survival analysis, we studied the predictive factors of severe outcomes occurrence, including treatment exposure (major glucocorticoids (GCs) exposure (>10 g of the cumulative dose) and tocilizumab (TCZ) exposure), as time-dependent covariates. Results: Among the 77 included patients, 26% were overweight (BMI ≥ 25 kg/m2). The mean cumulative dose of GCs was 7977 ± 4585 mg, 18 patients (23%) had a major GCs exposure, and 40 (52%) received TCZ. Over the 48-month mean follow-up period, 114 severe outcomes occurred in 77% of the patients: infections—29%, cardiovascular diseases—18%, hypertension—15%, fractural osteoporosis—8%, and deaths—6%. Baseline diabetes and overweight were predictive factors of severe outcomes onset (HR, 2.41 [1.05–5.55], p = 0.039; HR, 2.08 [1.14–3.81], p = 0.018, respectively) independently of age, sex, hypertension, and treatment exposure. Conclusion: Diabetic and overweight GCA patients constitute an at-risk group requiring tailored treatment, including vaccination. The effect of TCZ exposure on the reduction of severe outcomes was not proved here.

Mots clés: Tocilizumab; Cardiovascular events; Diabetes; Giant cell arteritis; Glucocorticoids; Infections; Overweight

Domaines: Médecine humaine et pathologie

Cyril Dumain, Jonathan Broner, Erik Arnaud, Emmanuel Dewavrin, Jan Holubar, et al.. Patients’ Baseline Characteristics, but Not Tocilizumab Exposure, Affect Severe Outcomes Onset in Giant Cell Arteritis: A Real-World Study. Journal of Clinical Medicine, 2022, 11 (11), pp.3115. ⟨10.3390/jcm11113115⟩. ⟨hal-03693299⟩