Vasculitis & polymyalgia rheumatica
Factors associated with tocilizumab primary failure in the treatment of giant cell arteritis
Authors' conclusion
Baseline CRP, LVV and prior relapses can be combined into a simple predictive score to stratify the probability of TCZ response in GCA. Complete metabolic extinction on FDG-PET/CT during treatment further identifies patients at risk of failure.
Study context
- Population
- Consecutive giant cell arteritis (GCA) patients receiving their first tocilizumab (TCZ) course at Caen University Hospital (2014–2024), excluding early withdrawal (<3 months)patients analysed
- Participants
- 91 patientsEvents: 48 (53%)
- Predictors
- Baseline model (CRP > 63.5 mg/L, large-vessel vasculitis, previous relapse before TCZ) combined into a predictive score; combined baseline-and-follow-up model incorporating FDG-PET/CT metabolic response
- Predicted outcome
- TCZ failure in GCA
Methodological detailsconsecutive patients, multivariable logistic regression models built using backward stepwise elimination
- Consecutive patients
- Multivariable logistic regression models built using backward stepwise elimination
Model performance
As reported in the abstract
AUC
Predictive score
0.774(95% CI 0.674-0.873)
Further findings
Baseline predictors of failure (multivariable analysis)
| OR for failure (95% CI) | P value | ||
|---|---|---|---|
| CRP > 63.5 mg/L | 3.40 (1.26–9.77) | P < 0.05 | |
| Large-vessel vasculitis (LVV) | 3.22 (1.18–9.44) | P < 0.05 | |
| Previous relapse before TCZ | 3.75 (1.16–9.41) | P < 0.05 | |
| 0.10.31310OR for failure (log scale) |
| Outcome | OR for failure (per additional month) (95% CI) | P value | |
|---|---|---|---|
| Duration of TCZ exposure and failureLower risk of failure with longer exposure | 0.911 (0.822–0.997) | P < 0.05 | |
| 0.512OR for failure (log scale) |
TCZ success and failure
- TCZ successful
- 43 (47%)
- TCZ failed
- 48 (53%)
PET/CT extinction status and treatment outcome (combined follow-up model)
- PET/CT extinction status significantly associated with treatment outcome overall
- P < 0.001
Original publication
Factors associated with tocilizumab primary failure in the treatment of giant cell arteritis. Joint Bone Spine. Published 3 November 2026. doi:10.
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