Giant cell arteritis (GCA) is an autoimmune condition that causes the inflammation of large and medium sized blood vessels. An alternative name for this condition is “Temporal Arteritis” as the blood vessels in the temple area of the head (sides of the forehead) are commonly affected. The “giant” cells are abnormal large cells that develop in the wall of the inflamed arteries. GCA is very rare in people younger than 50 years, and is more common in women and people of northern European descent. The cause of GCA is not known. The most common symptoms of GCA include headache, with severe pain and tenderness over the temples and the scalp, prominent blood vessels at the temples, and pain in the jaw or tongue when talking or chewing. Visual loss occurs in up to 20% of patients, and this may be related to late recognition.
Tocilizumab is a disease modifying drug that acts by blocking specific proteins that signal the inflammatory processes affecting blood vessels in GCA. It is currently licensed for the treatment of GCA in adults as a subcutaneous (under the skin) injection, but reactions at the place of injection include redness, itching and pain. It is anticipated that these reactions would be avoided if the drug was given as an intravenous infusion.
Apremilast works by suppressing the activity of inflammatory pathway caused by molecules such as interleukins and tumour necrosis factors. In turn this reduces inflammation. Currently, specific curative treatment options for Behçet’s disease are very limited and treatment relies on controlling symptoms and relieving pain. Apremilast has shown promise in targeting oral ulcers in patients with Behçet’s disease, and if licensed it could be an effective treatment option for this patient group.