Successful treatment of a patient with takayasu arteritis using a humanized anti–interleukin‐6 receptor antibody

Abstract

Takayasu arteritis (TA) is a chronic inflammatory disease that involves the aorta and its major branches. Since overproduction of interleukin-6 (IL-6) seems to play a pathogenic role in TA, we used the anti-IL-6 receptor (IL-6R) antibody tocilizumab to treat a 20-year-old woman with refractory active TA complicated by ulcerative colitis (UC). Treatment with tocilizumab improved the clinical manifestations of TA and the abnormal laboratory findings in this patient and ameliorated the activity of UC. These results indicate that IL-6R inhibition with tocilizumab might be a future treatment option for TA.

Tocilizumab for the Treatment of Patients With Refractory Takayasu Arteritis

“…33) In a refractory patient with TA, Nishimoto, et al reported that the serum TNF-α level fluctuated during TCZ therapy while the disease activity was well-controlled. 19) Taken together, these fi ndings indicate that TNF-α is upstream of IL-6 in the infl ammatory cytokine cascade and that TNF-α therapy may have a therapeutic effect in refractory patients with TA via the indirect reduction of IL-6 production.…”

“…In 2008, Nishimoto, et al reported the successful treatment of a patient with refractory TA accompanied by ulcerative colitis with TCZ. 19) TCZ (4 mg/kg/weekly and biweekly) rapidly induced improvements in the clinical manifestations and laboratory data, along with partial recovery of the ischemic symptoms. 19) In 2011, Seitz, et al reported that TCZ (8 mg/kg) was also effective in 7 patients with LVV (5 with GCA and 2 with TA) for a mean period of 4.3 months.…”

“…19) TCZ (4 mg/kg/weekly and biweekly) rapidly induced improvements in the clinical manifestations and laboratory data, along with partial recovery of the ischemic symptoms. 19) In 2011, Seitz, et al reported that TCZ (8 mg/kg) was also effective in 7 patients with LVV (5 with GCA and 2 with TA) for a mean period of 4.3 months. 21) Of these subjects, 2 who were newly diagnosed underwent TCZ monotherapy and 5 with a relapsing course were able to taper their GC dosage significantly from 29.5 mg/day at the first TCZ administration to 4.5 mg/day at 12 weeks.…”

“…Several recent studies have reported that IL-6 receptor (IL-6R) blockade with the IL-6R monoclonal antibody tocilizumab (TCZ) might be effective for the treatment of patients with refractory TA. [19][20][21][22] Since the mean time of TCZ administration in 3 recent pilot studies is a bit short (range, 3 to 12), [20][21][22] the safety and effi cacy of TCZ for patients with refractory TA need to be examined for longer periods. Here, we assessed the clinical, serological, and crosssectional imaging outcomes of 4 patients with refractory TA who were administered TCZ more than 24 times.…”

Anti‐interleukin‐6 receptor antibody, tocilizumab, for the treatment of autoimmune diseases

“…RA (in more than 90 countries worldwide) [36][37][38][39][40][41][42] Castleman's disease (in Japan) [52,53] Systemic and polyarticular JIA (in Japan) [57][58][59] Candidate diseases for tocilizumab therapy: Systemic autoimmune diseases SLE [130] Systemic sclerosis [115] Giant cell arteritis and Takayasu arteritis [90,91] Polymyositis Organ specific autoimmune diseases Crohn's disease [73] Relapsing polychondritis [108] Multiple sclerosis, neuromyelitis optica Acquired hemophilia A [149] Chronic inflammatory diseases Adult-onset Still's disease [61][62][63][64][65][66][67][68] Reactive AA amyloidosis [48][49][50][51] Polymyalgia rheumatica [80,91] RS3PE [85] Spondyloarthritides [100,[102][103][104][105] Behcet's disease Uveitis GVHD [150] Autoinflammatory diseases (TRAPS) [152] Tocilizumab has been approved as a biological drug for the treatment of RA, Castleman's disease and juvenile idiopathic arthritis, and is expected to be applicable to various other autoimmune and inflammatory diseases. Abbreviations: RA, rheumatoid arthritis; JIA, juvenile idiopathic arthritis; SLE, systemic lupus erythematosus; RS3PE, remitting seronegative, symmetrical synovitis with pitti...…”