Background Takayasu arteritis is a rare, chronic-relapsing idiopathic vasculitis affecting large vessels.
Objectives The objective of this study is evaluating the response and efficacy of Tocilizumab in Takayasu Arteritis (TA) treatment. Tocilizumab was started as a second treatment for resistant cases or as a first steroid sparing association treatment in order to achieve clinical remission as soon as possible.
Methods The patients (three women and one male) were selected from a our center as affected by active TA. Activity of disease was demonstrating by CT-PET in all patients. Inclusion criteria were resistance to anti-TNF (one patient) or treatment with high doses of prednisone (two patients) or refuse to use steroid (one patient).
Results The mean age at diagnosis was 32 years (17-45 years). Mean diagnostic delay 3.5 years (range 1-5 years).Three patients were on prednisone >15 mg/die. Three were treated with methotrexate (mean dose 15 mg/w, as tolerated). The other patient was on azathioprine 2 mg/kg. Two patients started remission treatment with prednisone 0.5 mg/kg and 1 mg/kg, methotrexate 15 mg/w and tocilizumab 8 mg/kg/4 w. The CT-PET was positive before Tocilizumab treatment in all patients. After four-six months of Tocilizumab, PET was negative in two patients (one of these patients developed later a positive PET when prednisone was reduced under 10 mg/die). One patient showed a reduced uptake of FDG glucose with a reduced SUV. The remaining patient was awaiting for CT-PET. CRP was elevated before treatment (mean 41.75 mg/dl, range 7-77) and negative after the first infusion of Tocilizumab. During Tocilizumab treatment no patients developed new arterial stenosis or worsening of known stenosis.
Conclusions Tocilizumab is a good option in anti-TNF resistant TA patients. It is useful as steroid-sparing treatment during remission and manteinance, but do not allow steroid suspension. Tocilizumab was a valid treatment in critically ill patient (severe aortic insufficiency) in order to achieve a rapid remission.
Disclosure of Interest None declared
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