Researchers from the Immunopathology Group of IDIVAL, led by Dr. Javier Loricera García and Dr. Ricardo Blanco Alonso, have carried out two studies to increase our knowledge of the complications derived from GCA. The first of them arises from the concern generated by the considerable proportion of patients with CGA who relapse despite conventional treatment with high-dose glucocorticoids, methotrexate and/or tocilizumab. The janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling pathway is implicated in the pathogenesis of GCA, so inhibitors of janus kinases (iJAK) may constitute a therapeutic alternative.
In the study, the effectiveness of iJAKs in refractory or recurrent GCA in clinical practice is evaluated and, in addition, a review of the literature in this regard is performed.
Analyzing 35 patients from thirteen Spanish hospitals and the Massachusetts General Hospital in Boston (USA), clinical remission, complete remission and safety are evaluated.
The results suggest that iJAKs could be effective in GCA, even in cases refractory to tocilizumab or methotrexate. Pending publication of the results of the randomized controlled clinical trial phase 3 of upadacitinib (NCT03725202), this study may help in making therapeutic decisions in patients with refractory/recurrent GCA.
The article has been published in the prestigious journal Arthritis Research and Therapy.
The second study stems from the need to test the effectiveness of tocilizumab in combating aortitis in GCA, which frequently leads to the formation of aneurysms.
A multicenter retrospective analysis of patients with aortitis secondary to GCA treated with tocilizumab from 57 Spanish hospitals was performed. Remission is evaluated according to the definition of the European Alliance of Rheumatology Associations (EULAR) and by imaging techniques. Clinical remission and normalization of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), the glucocorticoid-sparing effect, as well as the prevention and improvement of aneurysms are also measured.
From a sample of 196 patients, analyzed over two years, results suggest that patients with aortitis in the context of GCA treated with tocilizumab experience rapid and sustained clinical and laboratory improvement. However, this clinical and analytical improvement in many cases does not translate into an improvement in imaging tests. On the other hand, tocilizumab appears to prevent the development of new aneurysms in patients with GCA, but does not appear to prevent the progression of established aneurysms.
The results of that study are shown in the European Journal of Internal Medicine.
References:
Loricera J, Tofade T, Prieto-Peña D, Romero-Yuste S, de Miguel E, Riveros-Frutos A, Ferraz-Amaro I, Labrador E, Maiz O, Becerra E, Narváez J, Galíndez-Agirregoikoa E, González-Fernández I, Urruticoechea-Arana A, Ramos-Calvo Á, López-Gutiérrez F, Castañeda S, ºUnizony S, Blanco R. Effectiveness of janus kinase inhibitors in relapsing giant cell arteritis in real-world clinical practice and review of the literature. Arthritis Res Ther. 2024 Jun 5;26(1):116. doi: 10.1186/s13075-024-03314-9. PMID: 38840219; PMCID: PMC11151571.
Martín-Gutiérrez A, Loricera J, Narváez J, Aldasoro V, Maiz O, Vela P, Romero-Yuste S, de Miguel E, Galíndez-Agirregoikoa E, Fernández-López JC, Ferraz-Amaro I, Sánchez-Martín J, Moya P, Campos C, López-Gutiérrez F, Castañeda S, Blanco R; Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group. Effectiveness Of Tocilizumab In Aortitis And Aneurysms Associated With Giant Cell Arteritis. Eur J Intern Med. 2024 Jun 21:S0953-6205(24)00253-X. doi: 10.1016/j.ejim.2024.06.013. Epub ahead of print. PMID: 38908981.
