Anti-interleukin 6 receptor therapy as rescue treatment for giant cell arteritis
- Christian Beyer1,
- Roland Axmann2,
- Enijad Sahinbegovic1,
- Jörg H Distler1,
- Bernhard Manger1,
- Georg Schett1,
- Jochen Zwerina1,2
- 1Department of Internal Medicine 3, Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
- 2Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
- Correspondence to Jochen Zwerina, Department of Internal Medicine 3, Institute for Clinical Immunology, University of Erlangen-Nuremberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany;
- Accepted 21 March 2011
- Published Online First 24 April 2011
Treatment options for giant cell arteritis (GCA) are limited. Glucocorticoids are the mainstay of therapy, but relapses are common and often necessitate high cumulative doses of glucocorticoids.1,–,4 Interleukin 6 (IL-6) might be a key mediator of vascular inflammation in patients with GCA. Temporal artery biopsy samples show enhanced IL-6 production,5 and IL-6 levels generally correlate with disease activity.6 This prompted us to investigate the effects of anti-IL-6 receptor therapy with tocilizumab in three patients with refractory GCA.
Our first patient (79-year-old male) suffered from fever, night sweats and weight loss. Inflammation markers were elevated (C reactive protein (CRP) 168 mg/l), temporal artery biopsy showed typical histological signs and positron emission tomography (PET)/CT scans demonstrated large-vessel vasculitis (figure 1). Despite excellent initial response, we could not taper prednisone to doses less than 30 mg/day. Since methotrexate was contraindicated (chronic renal failure), we added azathioprine without clinical improvement.