Would you start tocilizumab in a patient with temporal arteritis and cirrhosis?

This is a challenging question as data regarding this question is lacking and the decision should be individualized to the specific presentation and through shared decision making.

In general, I would consider using TCZ in such clinical situations. While TCZ can cause hepatotoxicity, it's not typically severe. On the other hand, high dose prednisone in patients with cirrhosis may carry a significant risk of morbidity given increased susceptibility to infection, volume overload, and altered mental status. Given the lack of other steroid sparing agents (as opposed to RA), I believe TCZ is reasonable to consider.

It should also be kept in mind that patients with cirrhosis may have diminished conversion of prednisone to prednisolone, which may...