SAT0279 Tocilizumab in Refractory Aortitis: Study on 16 Patients and Literature Review

Abstract

Background Non-infectious aortitis is often refractory to standard immunosuppressive therapy. IL-6 has been implicated in the pathogenesis of aortitis. Objectives Our aim was to assess the efficacy of the anti-IL6 receptor monoconal antibody tocilizumab (TCZ) in a series of patients with refractory non-infectious aortitis. Methods We reviewed 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. Acknowledgements This study was supported by a grant from “Fondo de Investigaciones Sanitarias” PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2984

Giant Cell Arteritis: Beyond Corticosteroids

“…There are many case reports and series of efficacious and safe IL-6 receptor blockade with tocilizumab in refractory and relapsing cases of GCA, PMR and LVV [54][55][56]. Glucocorticoid-free clinical and imaging remission can be achieved with continuous therapy, although relapses are common after dose tapering or stopping tocilizumab.…”

Innovative Treatments for Takayasu’s Arteritis: A Focus on Interleukin-6 Inhibitors. The Authors’ Experience With Tocilizumab and a Review of Literature

“…У трех пациентов в одном исследовании [50] пос-ле первой инфузии ТЦЗ отмечена выраженная боль в шее (каротидиния), послужившая причиной отмены лечения. В 5 случаях (4,3%) на фоне лечения ТЦЗ развилась нейтро-пения [31,37,40,41,48], в том числе у двух больных она была расценена как тяжелая, у одной пациентки отмечена тромбоцитопения. Повышение уровней трансаминаз опи-сано у четырех больных, что у одного из них отнесено к серьезным НР.…”

Nagyérvasculitisek korszerű kezelése

“…Számos kisebb tanulmány és esetriport is hatékonynak találta GCA kezelésében [39][40][41][42][43][44][45][46][47][48].…”