Title (english) TREATMENT OF GIANT CELL ARTERITIS USING TOCILIZUMAB Title (croatian) LIJEČENJE ARTERITISA DIVOVSKIH STANICA TOCILIZUMABOM Author Daniel Victor Šimac Author Srđan Novak Author's institution University of Rijeka Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract (english) Giant cell arteritis (GCA) or temporal arteritis (TA) is a large-vessel vasculitis of the elderly which, if untreated, can lead to blindness. Glucocorticoids (GCs) remain the main treatment, but high-dose and long-term use can lead to serious side effects. Tocilizumab (TCZ) is increasingly used as an alternative steroid-sparing treatment option with promising results. This case series presents three GCA patients with a refractory form and/or at high risk for side effects treated with TCZ due to diagnoses of glaucoma and osteoporosis. Two of the patients responded to the treatment with good results. All three patients are elderly females who initially presented with classic symptoms of headache and/ or vision loss. The first patient also presented with fever, and the second with jaw claudication. Both of them were treated with pulses of GCs, but since the first also had osteoporosis with vertebral fractures, and the second had glaucoma and remained on high doses, TCZ was introduced. Both patients have since been stable. After approximately five years, the third patient developed TA with rheumatic polymyalgia, which was successfully treated with GCs. Later on TCZ was introduced as GCs could not be discontinued in consideration of the presence of osteoporosis and glaucoma. TCZ was discontinued after the patient developed neutropenia. Our case series presents two successful cases of treating GCA patients with TCZ, solidifying the recommendations for TCZ as a viable option for refractory disease and patients at high risk for side effects.
Abstract (croatian) Arteritis divovskih stanica (gigantocelularni arteritis – GCA) ili temporalni arteritis (TA) vaskulitis je velikih žila u starijih osoba koji može uzrokovati sljepoću ako se ne liječi. Kao standardna terapija još se upotrebljavaju glukokortikoidi (GK), ali njihove visoke doze i dugotrajna primjena mogu dovesti do teških nuspojava. Tocilizumab (TCZ) se sve više rabi kao alternativna poštedna steroidna terapija s dojmljivim rezultatima. U ovom radu prikazujemo tri pacijentice koje boluju od GCA refraktornog oblika i/ili se smatraju visokorizičnima zbog dijagnoze glaukoma ili roze, a liječene su TCZ-om koji je u dvije od njih dao dobre rezultate. Sve tri pacijentice starije su žene koje su primarno navele klasične simptome glavobolje i/ili gubitka vida. Prva pacijentica imala je i febrilitet, a druga je imala i klaudikacije čeljusti. Obje su liječene pulsevima GK. S obzirom na to da je prva pacijentica imala i osteoporozu s prijelomima kralježaka, a druga glaukom uz neuspješno sniženje doze GK, uveden je TCZ te su obje pacijentice otad stabilne. U
treće pacijentice razvio se TA nakon pet godina reumatske polimijalgije (PMR) uspješno liječene primjenom GK. Budući da ukidanje GK nije bilo moguće, s obzirom na dijagnoze osteoporoze i glaukoma TCZ je uveden poslije, ali je liječenje njime prekinuto nakon razvoja neutropenije. Naš prikaz dviju pacijentica oboljelih od GCA i uspješno liječenih primjenom TCZ-a podupire trenutačne smjernice koje TCZ navode kao održivu opciju za liječenje refraktornih bolesti i/ili bolesnika u kojih je viši rizik od razvoja nuspojava.
Keywords (english)
Giant cell arteritis – diagnosis, drug therapy
Temporal arteries – pathology
Glucocorticoids – adverse effects, therapeutic use
Antibodies, monoclonal, humanized – adverse effects, therapeutic use
Interleukin-6 – antagonists and inhibitors
Osteoporosis
Glaucoma
Keywords (croatian)
Arteritis divovskih stanica – dijagnoza, farmakoterapija
Temporalne arterije – patologija
Glukokortikoidi – nuspojave, terapijska uporaba
Humanizirana monoklonska protutijela – nuspojave, terapijska uporaba
Interleukin-6 – antagonisti i inhibitori
Osteoporoza
Glaukom
Language english Language croatian Publication type Scientific paper - Original scientific paper Publication status Published Peer review Peer review Publication version Published version Journal title Reumatizam Numbering vol. 67, no. 2, pp. 69-77 p-ISSN 0374-1338 e-ISSN 2459-6159 DOI https://doi.org/10.33004/reumatizam-67-2-6 URN:NBN urn:nbn:hr:184:546682 Publication 2020 Document URL https://hrcak.srce.hr/262171 Type of resource Text Access conditions Open access Terms of use Created on 2021-09-14 11:45:23
