323. REAL LIFE EXPERIENCE OF TOCILIZUMAB FOR THE MANAGEMENT OF GIANT CELL ARTERITIS IN FIFE, SCOTLAND

Abstract

Background: Tocilizumab was accepted by the Scottish Medicines Consortium for use in the management of Giant Cell Arteritis (GCA) on 10.09.18. The Fife Rheumatic Diseases Unit is the first Rheumatology unit in Scotland to introduce a structured process for the management of GCA patients with Tocilizumab. We describe here our experience of this new Service for NHS Fife. Method(s): All GCA patients considered for Tocilizumab are discussed at our weekly Medication Review Meeting by the Consultant Rheumatologists (JSM & SJH) and Rheumato Co ogy Pharmacist (SH). By consensus decision, GCA patients deemed appropriate for To to lizumab treatment are then referred to the Vasculitis Nurse Specialist (VNS; PA) for counselling. We have prospectively recorded data on all GCA patients counselled on Tocilizumab from 08.11.18 onwards. Patients are followed up closely in a structured manner by the VNS on a fortnightly basis, with both clinical and laboratory assessment at each visit. The VNS ensures that GCA patients follow a rapid steroid taper in line with that used in the GiACTA Trial. Patients also have laboratory assessments performed between each VNS visit at their General Practitioner's Surgery (to monitor the ESR) to assist in decision making in view of the rapid steroid taper. The VNS also records the cumulative steroid dose along with drug-related side effects (both from steroids and tocilizumab). Result(s): 4 GCA patients have been counselled and commenced on Tocilizumab between 08.11.18 and 3112.18. We have another 3 GCA patients awaiting counselling and due to start Tocilizumab in early January 2019. Six patients have newly diagnosed GCA (2 with unilateral visual loss) and one patient has GCA refractory to prednisolone and methotrexte. Of the 6 newly diagnosed patients, the reasons for initiating Tocilizumab were as follows : Poor control of diabetes mellitus on high dose steroids (3 cases); Large vessel vasculitis confirmed on PET scan; previous long-term steroid exposure due to past history of polymositis; high osteoporotic risk. Conclusion(s): We have successfully introduced a structured process for the use of Tocilizumab in Fife GCA patients via a VNS-led GCA clinic. This ensures robust clinical governance around the issues of safety, efficacy and cost. In addition, by collecting real life prospective data, we will add to the existing information available regarding use of this new therapeutic advance for GCA management in routine clinical practice. This initiative is the first of its kind in Scotland and a New Service development for NHS Fife.