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Glucocorticoids (GCs) are the gold standard for treatment of giant cell arteritis (GCA); however, there is a need for studies on GC-sparing agents, given that up to 85% of patients receiving GC only develop adverse events. Previous randomised controlled trials (RCTs) have applied different primary endpoints, limiting the comparison of treatment effects in meta-analyses and creating an undesired heterogeneity of outcomes. The harmonisation of response assessment is therefore an important unmet need in GCA research. In this viewpoint article, we discuss the challenges and opportunities with the development of new, internationally accepted response criteria. A change of disease activity is a fundamental component of response; however, it is debatable whether the ability to taper GC and/or the maintenance of a disease state for a specific time period, as applied in recent RCTs, should be part of response assessment. The role of imaging and novel laboratory biomarkers as possible objective markers of disease activity needs further investigation but might be a possibility when drugs directly or indirectly influence the levels of traditional acute-phase reactants such as erythrocyte sedimentation rate and C reactive protein. Futures response criteria might be constructed as a multidomain set, but the questions about which domains will be included and what their relative weights will be still need to be answered.

In recent years there has been growing interest in the use of tocilizumab for the treatment of large vessel vasculitis, particularly giant cell arteritis.1 Nakaoka et al recently suggested that tocilizumab may be of therapeutic benefit in patients with relapsing Takayasu arteritis (TAK).2 In this journal, a case of aortic ulceration in a patient with TAK while on tocilizumab was described.3 We report two additional patients who had disease progression despite tocilizumab therapy. ### Case 1 A 44-year-old woman with a 20-year history of seropositive rheumatoid arthritis in clinical remission on adalimumab presented with new-onset right upper extremity claudication. A diagnosis of TAK was made after angiography demonstrated arterial thickening of the aorta and arch branches with multifocal narrowing of the subclavian and common carotid arteries. …