Tocilizumab in refractory aortitis: study on 16 patients and literature review.

Abstract

OBJECTIVES:

Non-infectious aortitis is often refractory to standard immunosuppressive therapy. Since IL-6 has been implicated in the pathogenesis of aortitis, we assessed the efficacy of the anti-IL6 receptor monoconal antibody tocilizumab (TCZ) in a series of patients with refractory non-infectious aortitis.

METHODS:

Review of 16 patients (14 women/2 men) with refractory aortitis diagnosed by imaging (CT angiography, MR angiography, and/or PET) that were treated with TCZ.

RESULTS:

The mean age±SD was 51.4±20.1 years. The underlying conditions were: Takayasu arteritis (TakA) (n=7 cases), giant cell arteritis (GCA) (n=7), relapsing polychondritis (RP) (n=1), and aortitis associated with retroperitoneal fibrosis (n=1). TCZ was the first biologic drug used in all patients with GCA and in the patient with aortitis associated with retroperitoneal fibrosis but in only 2 of 7 TakA patients. In the remaining cases anti-TNF inhibitors were prescribed before TCZ (standard dose was 8 mg/kg/iv/4 weeks). After a mean±SD follow-up of 11.8±6.6 months most patients experienced clinical improvement, showing reduction of erythrocyte sedimentation rate from 43±36 mm/1st h to 5±4 mm/1st h at last visit. At TCZ onset, 25% of patients had fever and 19% polymyalgia rheumatica. These manifestations disappeared after 3 months of TCZ therapy. A corticosteroid sparing effect was also achieved (from 27.3±17.6 mg/day of prednisone at TCZ onset to 4.2±3.8 mg/day at last visit). TCZ had to be discontinued in a patient because of severe neutropenia.

CONCLUSIONS:

TCZ appears to be effective and relatively safe in patients with inflammatory aortitis refractory to corticosteroids or to other biologic immunosuppressive drugs.

• Authors: Javier Loricera, Ricardo Blanco, Santos Castañeda, Alicia Humbría, Norberto Ortego-Centeno, Javier Narváez, Cristina Mata, Sheila Melchor, Elena Aurrecoechea, Jaime Calvo-Alén, Pau Lluch, Concepción Moll, Mauricio Mínguez, Gabriel Herrero-Beaumont, Beatriz Bravo, Esteban Rubio, Mercedes Freire, Enriqueta Peiró, Carmen González-Vela, Javier Rueda-Gotor, Trinitario Pina, Natalia Palmou-Fontana, Vanesa Calvo-Río, Francisco Ortiz-Sanjuán, Miguel Ángel González-Gay
• Journal: Clinical and experimental rheumatology (Clin Exp Rheumatol) 2014 May-Jun Vol. 32 Issue 3 Suppl 82 Pg. S79-89 ISSN: 0392-856X [Print] Italy
• PMID: 24854377 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal, Humanized
• Glucocorticoids
• Immunosuppressive Agents
• Interleukin-6
• Receptors, Interleukin-6
• tocilizumab
• Prednisone

Topics

• Adult
• Aged
• Antibodies, Monoclonal, Humanized (administration & dosage, adverse effects)
• Aortitis (classification, diagnosis, drug therapy, immunology)
• Drug Monitoring
• Drug Resistance
• Female
• Glucocorticoids (administration & dosage, adverse effects)
• Humans
• Immunosuppressive Agents (administration & dosage, adverse effects)
• Interleukin-6 (blood)
• Magnetic Resonance Angiography (methods)
• Male
• Middle Aged
• Outcome Assessment, Health Care
• Positron-Emission Tomography (methods)
• Prednisone (administration & dosage, adverse effects)
• Receptors, Interleukin-6 (antagonists & inhibitors)
• Remission Induction (methods)
• Spain