When do you consider tapering tocilizumab in patients with GCA in remission?

This is a timely question and recent data sheds some light on this important topic. The risk of GCA relapse is approximately 50% (Mainbourg et al., PMID 30951256) in all comers. The GIACTA trial (Stone et al., PMID 28745999) utilized a one-year course of TCZ. A recent publication of the extension ph...

This is a very clinically relevant question as more data suggesting that tocilizumab is a very good option for patients with GCA becomes available. The benefits of tocilizumab include decreased need for corticosteroids while controlling disease activity and possibility of drug-free remission, at lea...

After a year, we try to taper everyone on steroids and most on tocilzumab. The taper is long and slow. We follow symptoms, CRP and ESR. If any increase or symptoms occur, we stop the taper and increase the medication.

An increasing number of male patients with GCA who go into remission and then relapse off treatment have VEXAS. They need to continue tocilizumab, and even then can become refractory to treatment. Further treatment options are either azacytidine or ruxolitinib. Not all patients with VEXAS have MDS, ...