Tocilizumab for the Treatment of Patients With Refractory Takayasu Arteritis

Abstract

SummaryTreatment of refractory Takayasu arteritis (TA) remains an unresolved clinical issue. Patients usually respond to glucocorticoid (GC) therapy, but often relapse on tapering of the GC dose. The aim of the present study was to assess the safety and effi cacy of the interleukin-6 (IL-6) receptor antibody tocilizumab (TCZ) in patients with TA refractory to conventional therapies including GC. Four patients with TA who had shown GC resistance received TCZ infusions (8 mg/ kg) every 4 weeks a total of at least 24 times (range, 24 to 51). Clinical symptoms, the serum levels of acute phase proteins and IL-6, GC dosage necessary to maintain remission, and cross-sectional imaging by enhanced CT and MRI were assessed. All patients achieved good clinical response and rapid normalization of the acute phase proteins such as C-reactive protein and serum amyloid A during the therapy with TCZ. The mean dosage of prednisolone could be reduced from 21.3 mg/day to 1.5 mg/day. Although the serum IL-6 level was transiently elevated in all patients after several TCZ infusions, it gradually recovered to the initial level. Along with the decrease of serum IL-6, two patients exhibited significant reduction in thickened arterial lesions. No drug-related adverse effects were noted. In this small group of patients with refractory TA, TCZ therapy was effective and well-tolerated. Further larger studies should be conducted to confi rm this fi nding. (Int Heart J 2013; 54: 405-411)

Efficacy of Biological-Targeted Treatments in Takayasu Arteritis

“…6 Preliminary studies have reported the efficacy of biological-targeting treatments such as TNF-α antagonists (infliximab, adalimumab, etanercept) and anti-IL-6 receptor (tocilizumab) in TA refractory to other immunosuppressive therapies. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Here, we report the long-term outcome of 49 TA patients treated with TNF-α antagonists and tocilizumab in this French nationwide study, and we compare their safety, their efficacy, and the factors predictive of treatment response.…”

Dramatic Response to Tocilizumab Before Emergency Surgery in Severe Active Takayasu Disease

“…Furthermore, reviews confirmed that tocilizumab may be an effective steroid-sparing option for rapid control of refractory disease activity in patients with Takayasu arteritis. 1,4 Finally, it has been shown that tocilizumab is efficient and well tolerated in patients with refractory Takayasu arteritis 1 ; based on our observation, it may be now an alternative for first-line therapy in selected cases.…”

“…In patients who remain resistant or intolerant to these agents, biological drugs including tumor necrosis factor inhibitors (infliximab) and tocilizumab are promising. 1 In the presence of a life-threatening arterial stenosis or occlusion, the mainstay of treatment is urgent revascularization of affected organs using surgical bypass, which is associated with lower morbidity-mortality than endovascular intervention. 2 Of note, as a general rule, both endovascular intervention and surgical procedures should be avoided during the active phase of the disease to decrease the risk of vascular complications (eg, restenosis).…”

Use of Anti TNF-α Therapy in Systemic Vasculitis

“…Overall, further placebo-controlled studies should be conducted to improve the current quality of evidence available for practicing clinicians. Table 1 shows a summary of studies that addressed the use of anti TNF-in patients with TA [17][18][19][20][21].…”