Tocilizumab in refractory Takayasu arteritis: a case series and updated literature review.

Abstract

BACKGROUND/PURPOSE:

The aim of this study is to analyze the efficacy and tolerance of tocilizumab in patients with Takayasu arteritis (TA).

METHODS:

We retrospectively studied patients with TA (ACR and/or Ishikawa's criteria): 5 French multicenter cases and 39 from the literature. Clinical, biological, radiological disease activity and treatment were analyzed before tocilizumab, during the follow-up and at the last available visit.

RESULTS:

Forty-four patients (median age 26years [3-65];) were included in the present study: 5 patients from the 3 French university hospitals and 39 cases from the literature review. Median follow-up after initiation of tocilizumab was 15months [8-33]. Clinical and biological activities significantly decreased within 3months, similarly to steroid amount (from 15mg/day [5-75] at baseline to 10mg/day [2-30] at 6months; p<0.05) and steroid-dependence rate. Even radiological activity did not significantly decrease at 6months, significant decrease of arterial FDG uptake was noted at 6months. Median duration of tocilizumab treatment was 9months [3-180]. At the last visit, tocilizumab was continued in 17/32 patients (53%), and was discontinued in the 15 remaining cases because of the remission (n=5), relapse (n=3), persistent radiological activity (n=3), cutaneous rash (n=2), severe infection (n=1) and lacking of care welfare system (n=1). No death related to tocilizumab treatment was noted.

CONCLUSION:

This study show the efficacy of tocilizumab in terms of clinical, biological and radiological response, as well as steroid-sparing agent. Only well-designed studies could definitely address the efficacy of tocilizumab in TA.

• Authors: Noémie Abisror, Arsene Mekinian, Christian Lavigne, Marie-Anne Vandenhende, Michael Soussan, Olivier Fain, Club Rhumatismes et Inflammation, and SNFMI
• Journal: Autoimmunity reviews (Autoimmun Rev) Vol. 12 Issue 12 Pg. 1143-9 (Oct 2013) ISSN: 1873-0183 [Electronic] Netherlands
• PMID: 23820042 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2013 Elsevier B.V. All rights reserved.

Chemical References

• Antibodies, Monoclonal, Humanized
• Immunosuppressive Agents
• Steroids
• tocilizumab

Topics

• Adolescent
• Adult
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Child
• Child, Preschool
• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Middle Aged
• Retrospective Studies
• Steroids (therapeutic use)
• Takayasu Arteritis (drug therapy)
• Treatment Outcome
• Young Adult