Tocilizumab in patients with Takayasu arteritis: a retrospective study and literature review

• Published in: Clinical and experimental rheumatology Vol. 34; no. 3 Suppl 97; pp. S44 - S53
• Main Authors: Loricera, Javier, Blanco, Ricardo, Hernández, José L, Castañeda, Santos, Humbría, Alicia, Ortego, Norberto, Bravo, Beatriz, Freire, Mercedes, Melchor, Sheila, Mínguez, Mauricio, Salvatierra, Juan, González-Vela, Carmen, Calvo-Río, Vanesa, Santos-Gómez, Montserrat, Pina, Trinitario, González-Gay, Miguel A
• Format: Journal Article
• Language: English
• Published: Italy 01.05.2016
• Subjects: Adolescent; Adult; Antibodies, Monoclonal, Humanized - therapeutic use; Child; Female; Humans; Middle Aged; Retrospective Studies; Takayasu Arteritis - drug therapy
• ISSN: 0392-856X

To assess the efficacy of tocilizumab (TCZ) in patients with Takayasu arteritis (TA). Multicentre open-label retrospective study. Eight patients (all women) with a mean age of 34±16 years, median 36 years (range: 7-57) were assessed. The main clinical features at TCZ therapy onset were: constitutional symptoms (n=4), fever (n=3), headache (n=2), chest pain (n=1), abdominal pain (n=1), mesenteric ischaemia (n=1), myalgia involving the lower limbs (n=1), cerebral vascular insufficiency (n=1), malaise (n=1), upper limb claudication (n=1) and nodular scleritis (n=1). Besides corticosteroids and before TCZ treatment onset, 7 of 8 patients had also received several conventional immunosuppressive and/or biologic agents. Seven patients experienced marked clinical improvement in the first 3 months after the onset of TCZ therapy. After a median follow-up of 15.5 [interquartile range-IQR: 12-24] months, 7 patients were asymptomatic. The median C-reactive protein decreased from 3.09 [IQR: 0.5-12] to 0.15 [IQR: 0.1-0.5] mg/dL (p=0.018), and median erythrocyte sedimentation rate from 40 [IQ range: 28-72] to 3 [IQR: 2-5] mm/1st hour (p=0.012). The median dose of prednisone was also tapered from 42.5 [IQR: 25-50] to 2.5 [IQR: 0-7.5] mg/day (p=0.011). However, TCZ had to be discontinued in 1 patient because she developed a systemic lupus erythematosus, and in another patient due to inefficiency. TCZ dose was reduced in a patient because of mild thrombocytopenia. TCZ appears to be effective in the management of patients with TA, in particular in patients refractory to corticosteroids and/or conventional immunosuppressive drugs.