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Tocilizumab for Induction and Maintenance of Remission in GCA
The Lancet
Published online March 4, 2016
Corticosteroids are the gold-standard treatment for giant cell arteritis (GCA), but they are associated with serious adverse events. Villiger et al. studied the safety and efficacy of tocilizumab, a humanized monoclonal antibody against the interleukin-6 receptor, as a steroid-sparing therapy. They found that tocilizumab effectively induced and maintained remission in GCA.
This was a single-center phase 2 randomized double-blind placebo-controlled trial of tocilizumab in patients aged 50 years or older with GCA. Patients with new-onset or relapsing disease were randomly assigned (2:1) to receive either tocilizumab (8 mg/kg) or placebo intravenously. They received 13 infusions in 4-week intervals until week 52. Both groups also took oral prednisolone, starting at a dosage of 1 mg/kg per day and tapering to 0 mg according to a standard reduction scheme defined in the study protocol.
The primary outcome measure was complete clinical disease remission of GCA, along with normal erythrocyte sedimentation rate and C-reactive protein at a prednisolone dose of 0.1 mg/kg per day at week 12. Vision was not an outcome measure.
Complete remission was achieved in 85% of tocilizumab patients at 12 and 52 weeks. In the placebo group, 40% of patients achieved remission at 12 weeks, and that rate dropped to 20% at 52 weeks. Serious adverse events were numerically equal in the tocilizumab and placebo groups, with a preponderance of serious gastrointestinal adverse events in the tocilizumab group, and cardiovascular and metabolic complications in the placebo group.
The researchers noted that a number of case series and an open-label study had found positive results with tocilizumab. Now, this first randomized placebo-controlled trial confirms the efficacy of the drug in inducing and maintaining remission of GCA.
Visual Recovery After Retinal Detachment With Macula Off
British Journal of Ophthalmology
Published online February 11, 2016
Frings et al. investigated the clinical importance of lag time between the onset of central visual acuity (VA) loss and surgical intervention for macula-off retinal detachment. They found that eyes surgically repaired within the first 3 days had better visual outcomes than those with delayed surgery.
In this retrospective case series, the researchers reviewed all consecutively treated eyes with primary macula-off retinal detachment (1,727) treated at a university hospital in Germany from February 2010 to February 2015. Of this group, only 89 eyes met all inclusion criteria. Eyes were repaired with either pars plana vitrectomy alone, phacovitrectomy, or scleral buckling based on the extent of retinal detachment and lens status. The main outcome measure was final VA as a function of the symptom duration (defined as time from onset of central VA loss to surgery) of macula-off detachment. Secondary outcome measures were the effect of age and surgical technique.
The researchers found that eyes with a symptom duration of 3 days or less achieved the best final VA; within this 3-day window, there were no significant differences. Further, they concluded that after 10 days of central VA loss, the final visual outcome was clinically comparable to that of surgery delayed up to 30 days. Age and preoperative VA had no influence, but vitrectomized eyes had a better outcome than those treated with scleral buckling.
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Other Journals summaries are written by Marianne Doran and edited by Deepak P. Edward, MD.
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