Tocilizumab Associated With Fewer Cardiovascular Events Than Methotrexate in Giant Cell Arteritis

Giant cell arteritis carries increased cardiovascular risk, but whether steroid-sparing treatments differ in their cardiovascular effects remains uncertain. Researchers used the French National Health Data System for 2012–2024 to emulate a target trial among 1,997 patients hospitalized for incident giant cell arteritis. Within six months after discharge, 1,095 initiated tocilizumab and 902 initiated methotrexate. Mean age was 73.1 years, and 70.4% were women. The primary endpoint combined coronary events, ischemic stroke, and all-cause death.

At two years, estimated cumulative endpoint incidence was 6.4% with tocilizumab and 10.7% with methotrexate, an absolute risk difference of −4.3 percentage points (95% CI, −6.6 to −1.7). Tocilizumab was associated with lower composite risk (hazard ratio, 0.60; 95% CI, 0.48–0.75), driven by fewer coronary events (hazard ratio, 0.55; 95% CI, 0.37–0.84) and all-cause deaths (hazard ratio, 0.53; 95% CI, 0.36–0.74). Results were consistent across sensitivity analyses, and negative control outcomes did not differ meaningfully.

The findings suggest a potentially relevant cardiovascular difference between these treatment strategies. However, despite clone-censor-weight methods and inverse probability weighting, this observational comparison cannot establish causality or exclude residual confounding. The composite included all-cause rather than cardiovascular death, and the population was restricted to patients hospitalized with incident disease. Only the abstract was available for assessment.