Based on these findings, Dr. Stone emphasized that an effective steroid-sparing medication for GCA is now available for the first time in 67 years “since the invention of cortisone in 1949. … This is a great achievement for rheumatology and for patients with GCA,” he said.
Although both dosing schedules of tocilizumab showed significant benefit compared with prednisone alone, Dr. Stone speculated that most clinicians would choose to use the once-weekly dosing because of the critical need to quickly and completely shut down inflammation from GCA to avoid irreversible damage, such as vision loss and complications of large-vessel vasculitis.
Dr. Stone also highlighted the need for a paradigm shift in how clinicians think about GCA. “In addition to beginning steroids promptly when this diagnosis is suspected, we also need to begin treatment with tocilizumab once the diagnosis is confirmed,” he said. “Failure to exert and maintain disease control only leads to increasing steroid toxicity over time and places patients at risk for serious complications of GCA.”
‘I think most rheumatologists will find it surprising that the therapy we have regarded as the standard of care [prednisone only]—that has been the standard of care for many decades—fared so poorly.’ —Dr. Stone
Survival Benefit with Statins
Amar Oza, MD, clinical fellow, Department of Rheumatology, Massachusetts General Hospital, presented data from a population-based cohort showing a survival benefit of statins in patients with PsA and AS.
Data from The Health Improvement Network (a United Kingdom population database) were used to identify patients with PsA and AS between January 2000 and December 2014. Investigators quantified the all-cause mortality reduction in patients initiated on statins compared to propensity-matched patients not initiated on statins.
The study found that statin initiation was associated with a 32% reduction in all-cause mortality, with a hazard ratio of 0.68 (95% CI, 0.57–0.81). Along with suggesting that statins may be beneficial in lowering the risk of all-cause mortality in patients with AS and PsA, Dr. Oza said the results suggest that “the magnitude of this mortality reduction is larger than large meta-analyses of the general population, on the order of 9–14%.”
Dr. Oza said that a future study will look at biologic treatment and adherence, because the current study did not include these medications.
Lowering Uric Acid Improves Chronic Kidney Disease
Gerald D. Levy, MD, rheumatologist, Kaiser Permanente, Downey, Calif., presented data from a large retrospective cohort of patients with hyperuricemia that showed that lowering uric acid (UA) levels to below 6 mg/dL improved both hyperuricemia and chronic kidney disease (CKD).
