Long-term efficacy and safety of tocilizumab in giant cell arteritis and large vessel vasculitis

Abstract

Giant cell arteritis (GCA) is a chronic systemic vasculitis affecting large-sized and medium-sized vessels. Glucocorticoids are currently the mainstay of treatment for GCA and associated large vessel vasculitis (LVV) but are associated with frequent adverse events. Methotrexate has only demonstrated a modest benefit while anti-TNF biological agents (infliximab and etanercept) have been inefficacious. Elevated levels of interleukin-6 (IL-6), a proinflammatory cytokine, has been associated with GCA. Tocilizumab (TCZ), a humanised antihuman IL-6 receptor antibody, has been used successfully in several reports as a treatment for GCA and LVV. We report the potentially long-term successful use of TCZ in 8 cases of refractory LVV. All of our patients achieved a good clinical response to TCZ and C reactive protein reduced from an average of 70.3 to 2.5. In all cases, the glucocorticoid dose was reduced, from an average of 24.6 mg prednisolone prior to TCZ treatment to 4.7 mg, indicating that TCZ may enable a reduction in glucocorticoid-associated adverse events. However, regular TCZ administration was needed for disease control in most cases. TCZ was discontinued in one case due to the development of an empyema indicating the need for careful monitoring of infection when using this treatment.

Steroid-sparing effect and toxicity of dapsone treatment in giant cell arteritis

“…[14] Indeed, several open-label studies using TCZ reported remission and maintenance thereof in refractory GCA patients. [12,13,15,42,43] However, serious side effects including neutropenia, hepatitis, and infections were reported in these studies in up to 27%, and death occurred in 3 patients. Furthermore, data on the frequency of relapses after TCZ withdrawal are lacking in these studies.…”

Mast cells and primary systemic vasculitides

“…Rituximab is a synthetic antibody that selectively reduces the number of B cells circulating in the blood, and it helps to decrease inflammation without the use of steroids. A humanized anti‐human IL‐6 receptor antibody tocilizumab has been successfully used and in eight cases of refractory large‐vessel vasculitis and CGA . Mepolizumab, an anti‐IL‐5 monoclonal antibody that binds to IL‐5 and prevents its interaction with its receptor on the eosinophil surface, has been used in the treatment of eosinophilic granulomatosis with polyangiitis (Churg‐Strauss syndrome) …”

A nyelv necrosisa mint az arteritis temporalis szokatlan manifesztációja

“…A más intéz-ményben végzett sürgősségi vizsgálatok során -mellkasröntgenen, koponya CT-n -kóros nem volt. Laboratóri-umi leleteiből magas C-reaktív protein (196 mg/L) és Westergreen-érték (70 mm/h), leukocytosis (11,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)5 G/L) emelhető ki. Sürgősséggel elvégzett anti-DNS-, anti-MPO-, anti-PR3-, anti-GBM-antitest-vizsgálatok és antifoszfolipidantitest-vizsgálatok negatívak lettek.…”

“…A citosztatikumok kedvező hatását nem sikerült bizonyítani [2,4,12]. A biológiai terápiákkal kapcsolatban egyelőre kevés és kis betegszámú vizsgálat, csekély tapasztalat áll rendelkezésre, tocilizumabbal történt kis betegszámú vizsgálatok során biztató eredmények láttak napvilágot [13].…”