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

Abstract

OBJECTIVES:

To assess the efficacy of tocilizumab (TCZ) in patients with Takayasu arteritis (TA).

METHODS:

Multicentre open-label retrospective study.

RESULTS:

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.

CONCLUSIONS:

TCZ appears to be effective in the management of patients with TA, in particular in patients refractory to corticosteroids and/or conventional immunosuppressive drugs.

• Authors: Javier Loricera, Ricardo Blanco, José L Hernández, Santos Castañeda, Alicia Humbría, Norberto Ortego, Beatriz Bravo, Mercedes Freire, Sheila Melchor, Mauricio Mínguez, Juan Salvatierra, Carmen González-Vela, Vanesa Calvo-Río, Montserrat Santos-Gómez, Trinitario Pina, Miguel A González-Gay
• Journal: Clinical and experimental rheumatology (Clin Exp Rheumatol) 2016 May-Jun Vol. 34 Issue 3 Suppl 97 Pg. S44-53 ISSN: 0392-856X [Print] Italy
• PMID: 27050507 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Antibodies, Monoclonal, Humanized
• tocilizumab

Topics

• Adolescent
• Adult
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Child
• Female
• Humans
• Middle Aged
• Retrospective Studies
• Takayasu Arteritis (drug therapy)