Background Takayasu’s arteritis (TA) is a chronic vasculitis that involves aorta and its main branches, where interleukin-6 (IL-6) seems to play a pathogenic role (1,2). The effect in four patients treated with the anti-IL-6 receptor (IL-6R) antibody Tocilizumab was evaluated.
Objectives to describe the effect of Tocilizumab in patients of Takayasu’s arteritis.
Methods We reviewed the clinical records of 4 patients with TA diagnosed according to current criteria, treated between 2010 and 2011 in a tertiary center in Cali, Colombia. Four patients with a refractory disease to multiple treatments, was began treatment with Tocilizumab at a dose of 8 mg/kg every month in association with metothrexate and/or steroids. Two patients were treated previously with infliximab (IFX) without control of disease. This cases were reported previously (3).
Results The cases summaries are as follows: Case 1. A 30 year-old woman with a diagnosis of TA since 2003 presented panaortitis, with involvement of supra-aortic, coronaries, mesenteric and kidney vessels. She received high doses of steroids, azathioprine, cyclosporin and IFX, without control of the symptoms. We began tocilizumab in may of 2010 with resolution of symptoms, improvement of pulses and reduction of levels of acute-phase proteins. Case 2. A 14 year-old woman with a diagnosis of TA since 2010, with involvement of descending aorta, supra-aortic, mesenteric and kidney vessels. She was treated with prednisolone and metothrexate, persisting pain in right arm and paresthesias. Tocilizumab was started in may of 2011, with improvement of symptoms and reductions of levels of acute-phase proteins and dose of steroids. Case 3. A 32 year-old woman with TA since 2003, refractory despite to conventional treatment. She complained of pain in limbs and malaise. We began tocilizumab in august of 2011, with improvement of symptoms and reduction of levels of acute-phase proteins. Case 4. A 32 year-old woman with TA since 2007, with pain in right arm and neck and fatigue. She was treated with steroid and azathioprine without achieve control of symptoms. Then she began tocilizumab in september of 2011, with resolution of pain and reductions of levels of acute-phase proteins. In last control she continue free of symptoms.
Conclusions In our cases, the treatment of Takayasu’s arteritis with tocilizumab achieving control of symptoms and reductions of markers of inflammation, including patients who previously was treated with IFX. Future clinical studies will be required to establish long-term safety and efficacy.
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Seitz M, Reichenbach S, Bonel HM, Adler S et al. Rapid induction of remission in large vessel vasculitis by IL-6 blockade. Swiss Med Wkly 2011; 141: 1-4
Cañas C, Bonilla F, Caicedo A. The patient’s outcome with Takayasu’s arteritis treated with infliximab. Ann Rheum Dis 2010; 69 (Suppl 3): 223
Disclosure of Interest None Declared