P184 Developing a pathway for tocilizumab treatment in giant cell arteritis: a South London regional experience

• Published in: Rheumatology (Oxford, England) England), 2020-04, Vol.59 (Supplement_2)
• Main Authors: Saha, Pratyasha, Sandhu, Virinderjit, Robinson, Helena, Ezeonyeji, Amara, Al-Shakarchi, Israa, Chander, Sumeet, Suresh, Resmy, Kaul, Arvind, Sofat, Nidhi
• Format: Article
• Language: English
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/keaa111.179

Abstract Background Tocilizumab is now approved by the National Institute of Health and Care Excellence (NICE) for up to a year in relapsing or refractory giant cell arteritis (GCA). The practicalities of developing a pathway for referral using a hub and spoke model were previously unknown. Here we discuss our novel experiences utilising tocilizumab for GCA in its first year of licensing, after the introduction of a new regional multi-disciplinary team referral pathway. Methods We assessed all patients started on tocilizumab for GCA between August 2018-May 2019. The central assessing hub is St George’s University Hospitals NHS Foundation Trust, a large tertiary rheumatology department in the South of England, serving a population of 1.3 million. Results As per Table 1 below. A total of 9 patients were identified: 6 female and 3 male, with an average age of 74.2 (range 63-80). 5 patients were referred internally from clinicians at St George’s Hospital, with the remainder from local district general hospitals. Steroid protocols between patients were varied, and two-thirds required a 3-day IV methylprednisolone course, including all 4 patients with visual symptoms. A third of patients were on concurrent methotrexate, a disease-modifying antirheumatic drug. 8 of 9 patients were on alendronate, vitamin D/calcium, and a gastroprotective agent, and 7 were on aspirin. Reported side effects from steroids were common, with weight gain, increased appetite and osteoporosis noted. All our 9 patients continue their tocilizumab injections, with one individual having a 3-month break for a routine hip operation, and another a 1-month hiatus due to temporary derangement in liver function tests. Tocilizumab proffered improved disease control and few side effects were noted. 3 patients have now been on tocilizumab for 12 months and raise interesting discussions about ongoing funding and treatment efficacy. P184 Table 1: Data collected from 9 patients with giant cell arteritis on tocilizumab treatment Patient number 1 2 3 4 5 6 7 8 9 Age 78 78 74 74 78 80 73 70 63 Sex M M M F F F F F F Duration of GCA disease (months) 10 11 10 31 80 72 15 14 171 Steroid dose at start of TOC (mg) 50 20 40 20 25 10 60 40 - Most recent steroid dose (mg) and date 20mg, May 2019 20mg, Jun 2019 17.5mg, Sep 2019 6mg, Jun 2019 6mg, Aug 2019 4mg, Oct 2019 7mg, Jul 2019 - 5mg, Jul 2019 Months on TOC (as of Oct 2019) 7 4 4 7 12 11 12 12 - Concurrent DMARDs and dose MTX 10mg qw - - MTX 15mg qw - - - - MTX