Giant cell arteritis (GCA) is a chronic inflammatory disease that affects the aorta and its medium- and large-sized branches (1). Glucocorticoids are the most effective treatment for GCA to rapidly extinguish acute inflammation at disease onset, minimize the risk of ischaemic complications, prevent relapses, and restore remission after a flare (2,3). However, a large proportion of patients are unable to taper off glucocorticoids and steroid-related side effects are prevalent ([4], [5], [6]). For this reason, in the last decade, clinical research in the field of GCA has focused on finding steroid-sparing therapies (7). To date, only one agent has been demonstrated to be effective in GCA: the interleukin (IL)-6 receptor antagonist tocilizumab. In a phase-3 double-blind randomized-controlled trial (the Giant-Cell Arteritis Actemra [GiACTA] trial), treatment with weekly or every-other-week subcutaneous tocilizumab for one year combined with a 26-week prednisone taper was superior to placebo to maintain glucocorticoid-free remission (8). After the publication of this trial, weekly tocilizumab was approved and included in both European and American Rheumatology Societies recommendations (9,10). Despite adoption of tocilizumab into clinical management strategies for GCA, there remains uncertainty regarding treatment duration and the optimal approach to medication suspension. The recent publication of the open-label extension phase of the GiACTA trial did not help to mitigate this uncertainty, since 58% of patients treated with a 12-month course of weekly tocilizumab had a disease flare in the 2 years following therapy suspension (11).

Here, we evaluated the effectiveness of subcutaneous tocilizumab to induce and maintain remission when given weekly for one year followed by another year of every-other-week administration.