What to do after 12 months of Tocilizumab for GCA?
Last week I had the privilege of presenting on “Challenges in GCA Clinical Practice: Navigating Therapy” alongside Dr Clare Owens and A/Prof Jason Chuen at the 2023 Australian Rheumatology Association annual conference in Hobart.
As most people who have GCA, or look after patients with GCA know, Tocilizumab is generally a well tolerated and effective treatment. The optimal duration of therapy and longer term dosing schedule, however, is unclear, and PBS only subsides 12 months of supply. A large part of my talk addressed this issue. To summarise, there are 3 broad approaches at 12 months – all with pros and cons and the decision needs to be tailored to the individual patient:
- Continue Tocilizumab but reduce to a fortnightly regime. This has the benefit of reducing medication cost and still is highly effective in controlling the disease.
- Discontinue Tocilizumab after 12 months. This may be reasonable for lower risk patients who want to stop therapy and are happy to accept a 50-60% risk of relapse in the following 2 years
- Start a conventional steroid sparing agent. Studies of patients taking methotrexate and leflunomide (less robust evidence) have shown that these agents probably reduce the chance of relapse
The session was chaired by Melbourne rheumatologists Dr David Liew and Prof Stephen Hall. Steve has been a vasculitis mentor to me since early in my training. It was great to share the stage and field questions from David, Steve and the floor!
