Brandon Stretton, Yiran Tan, Mark Hassall, Sumu Simon
Purpose: To describe the possible role for tocilizumab as a rescue therapy in glucocorticoid resistant giant cell arteritis (GCA).
Method: We conducted a retrospective review of consec- utive patients with glucocorticoid resistant GCA treated with tocilizumab at the Royal Adelaide Hospital, Australia between 1 June 2019 to 1 March 2021. Gluco-corticoid resistant GCA was defined by clinical progres- sion of optic nerve compromise or persistently elevated inflammatory markers despite intravenous methylpred- nisolone treatment in patients with a histological diagnosis of GCA.
Results: Five patients were identified in this case series, all of whom presented with acute monocular vision loss. Three patients (60%) experienced an improvement in visual acuity in at least one eye following initiation of tocilizumab therapy. No adverse effects associated with tocilizumab treatment were observed during follow-up.
Conclusion: Our case series serves to demonstrate that there is a role of the use of tocilizumab as “rescue” therapy for glucocorticoid-resistant GCA, where severe vision loss would otherwise be imminent. There is insufficient evidence to determine what proportion of visual recovery is due to the effect of tocilizumab alone.