Coming to a hard stop? Effect of tapered tocilizumab after weekly tocilizumab cessation for GCA: a multicentre evaluation

Vanessa Quick; Stephen Sah; Shirish Dubey; Louise Mercer; Jagdish R Nair; Fiona L Coath; Muhammad Kurshid; Mahdi Abusalameh; Sajeel Ahmed; Hoda Alkoky; Marwan Bukhari; Stuart Carter; Brian Davidson; Parveen Doddamani; Georgina Ducker; Bridget Griffiths; Nicola Gullick; Jonathan Heaney; Amelia Holloway; Ei Ei Phyu Htut; Mark Hughes; Hannah Irvine; Alison Kinder; Joyce Lim; Dalia R Ludwig; Mariam Malik; Ben Mulhearn; Rikesh Patel; Joanna Robson; Pratyasha Saha; Sarah Tansley; Sarah L Mackie; TOC STOP 2022 Investigators

doi:10.1093/rheumatology/keaf450

Coming to a hard stop? Effect of tapered tocilizumab after weekly tocilizumab cessation for GCA: a multicentre evaluation

Rheumatology (Oxford). 2026 Jan 8;65(1):keaf450. doi: 10.1093/rheumatology/keaf450.

Authors

Vanessa Quick¹, Stephen Sah^{1

2}, Shirish Dubey^{3

4}, Louise Mercer⁵, Jagdish R Nair^{6

7}, Fiona L Coath^{8

9}, Muhammad Kurshid¹⁰, Mahdi Abusalameh^{11

12}, Sajeel Ahmed^{13

14}, Hoda Alkoky¹, Marwan Bukhari^{15

16}, Stuart Carter¹⁷, Brian Davidson¹⁸, Parveen Doddamani^{19

20}, Georgina Ducker⁹, Bridget Griffiths¹³, Nicola Gullick^{21

22}, Jonathan Heaney¹³, Amelia Holloway^{23

24}, Ei Ei Phyu Htut²⁰, Mark Hughes²⁵, Hannah Irvine^{3

4}, Alison Kinder¹⁹, Joyce Lim²⁶, Dalia R Ludwig²⁴, Mariam Malik^{18

27}, Ben Mulhearn^{16

28}, Rikesh Patel²⁹, Joanna Robson^{30

31}, Pratyasha Saha⁹, Sarah Tansley^{28

32}, Sarah L Mackie^{26

33}; TOC STOP 2022 Investigators

Collaborators

TOC STOP 2022 Investigators:
Saad Ahmed, Ismael Atchia, James Bluett, Alex Connew, Elizabeth Coulson, Helena Crawshaw, Ursula Davies, Denise De Lord, Gurdeep Dulay, Amanda Embuldeniya, Fonseca Carmen, James Galloway, William Gubbins, Thushyanthan Guruparan, Rebecca Heaton, Martin James, Shalini Janagan, Hilary Johnson, Areej Karim, Salema Khalid, Kath Kinsey, Gouri Koduri, Stuart Linton, Elizabeth MacPhie, Arti Mahto, Chetan Mukhtyar, Anupama C Nandagudi, Pradip Nandi, Fathelrahman Osman, Sophie Plumb, Eavan Quinlan, Angela Redfern, Marian Regan, Vanessa Reid, Dipak Roy, Sadaf Saeed, Abbey Smith, Lauren Steel, Rhys Thomas, Adaeze Ugwoke, Sarah Villar, Emma Williams, Fiona Wood, Mingrui Xie

Affiliations

¹ Rheumatology Department, Luton and Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK.
² Hammersmith Medicines Research, London, UK.
³ Department of Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁴ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
⁵ Rheumatology Department, Stockport NHS Foundation Trust, Stockport, UK.
⁶ Rheumatology Department, Liverpool University Hospitals (Aintree), Liverpool, UK.
⁷ The National Behcet's Centre of Excellence, Liverpool, UK.
⁸ Rheumatology Department, Southend University Hospital NHS Trust, Southend, UK.
⁹ Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
¹⁰ Rheumatology Department, University Hospitals Dorset NHS Foundation Trust, Dorset, UK.
¹¹ Rheumatology Department, Royal Devon University Healthcare NHS Foundation Trust, Devon, UK.
¹² Faculty of Medicine, Arab American University, Jenin, Palestine.
¹³ Rheumatology Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
¹⁴ Rheumatology Department, University Hospital of North Tees, Stockton, UK.
¹⁵ Lancaster University, Lancaster, UK.
¹⁶ Rheumatology Department, Royal Lancaster Infirmary, Lancaster, UK.
¹⁷ Rheumatology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
¹⁸ Rheumatology Department, Southampton University Hospitals NHS Foundation Trust, Southampton, UK.
¹⁹ Rheumatology Department, University Hospitals of Leicester NHS Trust, Leicester, UK.
²⁰ Department of Rheumatology, Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK.
²¹ Rheumatology Department, University Hospitals Coventry & Warwickshire NHS Trust, Warwickshire, UK.
²² Rheumatology Department, Coventry & Warwick Medical School, University of Warwick, Warwick, UK.
²³ Rheumatology Department, Kings College Hospital NHS Foundation Trust, London, UK.
²⁴ Rheumatology Department, University College London NHS Foundation Trust, London, UK.
²⁵ Rheumatology Department, Royal Cornwall Hospitals NHS Trust, Cornwall, UK.
²⁶ Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
²⁷ Rheumatology Department, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK.
²⁸ Royal United Hospital for Rheumatic Diseases, Royal United Hospitals Bath, Bath, UK.
²⁹ Rheumatology Department, Manchester University Foundation NHS Trust, Manchester Royal Infirmary, Manchester, UK.
³⁰ Centre for Health and Clinical Research, University of the West of England, Bristol, UK.
³¹ Department of Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
³² Department of Life Sciences, University of Bath, Bath, UK.
³³ NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

PMID: 40857555
DOI: 10.1093/rheumatology/keaf450

Abstract

Objectives: In England, there is a 'hard stop' to weekly tocilizumab (qwTCZ) therapy for GCA; this is currently 12 months but was extended during the COVID-19 pandemic subject to certain criteria for GCA relapse risk. Taking advantage of variation in practice, we aimed to compare outcomes of GCA patients who tapered-TCZ vs those who stopped abruptly (non-taper patients).

Methods: Secondary analysis of an English multicentre service evaluation of relapse after stopping qwTCZ for GCA. Time to relapse was compared between taper and non-taper patients. We examined outcomes according to whether they had been 'adequate responders' during qwTCZ therapy, defined as those in remission and on ≤5 mg prednisolone at qwTCZ cessation, without relapse whilst taking qwTCZ.

Results: We analysed 336 patients from 40 centres. Time to relapse after qwTCZ cessation was significantly longer in adequate responders than non-adequate responders (P = 0.0004). 17.0% (57/336) patients tapered to fortnightly TCZ after qwTCZ cessation, for a median of 6 (IQR 2-13) months. For adequate responders, time to relapse whilst taking tapered-dose TCZ was significantly longer compared with those in the non-taper group (P = 0.0231) based on a relatively small number of flares. There was no difference between the taper and non-tapered groups after tapered-TCZ was stopped (P = 0.8346). In contrast, time to relapse for non-adequate responders was similar in taper patients compared with non-taper patients (P = 0.4892).

Conclusion: Tapering TCZ after qwTCZ cessation delayed relapse only during the tapering period, but only in adequate responders to qwTCZ. No lasting benefit was seen after tapering ended.

Keywords: GCA; dose optimization; relapse; service evaluation; tocilizumab; vasculitis.

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Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Antibodies, Monoclonal, Humanized* / administration & dosage
Antibodies, Monoclonal, Humanized* / therapeutic use
COVID-19 / epidemiology
Drug Administration Schedule
Drug Tapering*
Female
Humans
Male
Middle Aged
Prednisolone / administration & dosage
Prednisolone / therapeutic use
Recurrence
SARS-CoV-2
Treatment Outcome

Substances

tocilizumab
Antibodies, Monoclonal, Humanized
Prednisolone