Mohammed Osman1, Derek Emery2, Elaine Yacyshyn3. 1. Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 2. Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada. 3. Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: eyacyshyn@ualberta.ca.
Abstract
BACKGROUND: Takayasu's arteritis (TA) is a rare inflammatory disease that can result in stroke. Treatment of patients with TA requires prolonged use of corticosteroids (CS). We assessed the effectiveness of tocilizumab (TCZ) in inducing disease remission and reducing CS doses in patients with TA. METHODS: We retrospectively reviewed all patients with TA treated with TCZ and determined their response to therapy and adverse effects. We also summarized all reported TA patients treated with TCZ in the literature (both PubMed and MEDLINE) with no date or language restrictions and determined the utility of TCZ in inducing remission, acting as a CS sparing agent, and its adverse effects. RESULTS: TCZ induced remission and reduction of CS doses in all 3 cases of TA in our cohort. Remission was achieved in 2 patients where stroke was the initial manifestation of active TA. In total, 3 of 4 patients with TA and stroke (2 from our study and 2 from other studies) treated with TCZ achieved remission and stability of their disease. We also identified 30 patients with TA treated with TCZ in the literature, of which 76.7% achieved remission despite the lack of sustained remission with other biological agents. In addition, TCZ resulted in a statistically significant reduction of CS in patients on CS before using TCZ (median, -8.8 mg/day; interquartile range, -19.4, to -3.4 mg/day; Wilcoxon P value, .0002). CONCLUSIONS: TCZ is a promising alternative for treating TA refractory to other biologics and for TA patients with stroke.
BACKGROUND:Takayasu's arteritis (TA) is a rare inflammatory disease that can result in stroke. Treatment of patients with TA requires prolonged use of corticosteroids (CS). We assessed the effectiveness of tocilizumab (TCZ) in inducing disease remission and reducing CS doses in patients with TA. METHODS: We retrospectively reviewed all patients with TA treated with TCZ and determined their response to therapy and adverse effects. We also summarized all reported TA patients treated with TCZ in the literature (both PubMed and MEDLINE) with no date or language restrictions and determined the utility of TCZ in inducing remission, acting as a CS sparing agent, and its adverse effects. RESULTS:TCZ induced remission and reduction of CS doses in all 3 cases of TA in our cohort. Remission was achieved in 2 patients where stroke was the initial manifestation of active TA. In total, 3 of 4 patients with TA and stroke (2 from our study and 2 from other studies) treated with TCZ achieved remission and stability of their disease. We also identified 30 patients with TA treated with TCZ in the literature, of which 76.7% achieved remission despite the lack of sustained remission with other biological agents. In addition, TCZ resulted in a statistically significant reduction of CS in patients on CS before using TCZ (median, -8.8 mg/day; interquartile range, -19.4, to -3.4 mg/day; Wilcoxon P value, .0002). CONCLUSIONS:TCZ is a promising alternative for treating TA refractory to other biologics and for TA patients with stroke.
Authors: Diana Prieto-Peña; Pilar Bernabeu; Paloma Vela; Javier Narváez; Jesús C Fernández-López; Mercedes Freire-González; Beatriz González-Álvarez; Roser Solans-Laqué; José L Callejas Rubio; Norberto Ortego; Carlos Fernández-Díaz; Esteban Rubio; Salvador García-Morillo; Mauricio Minguez; Cristina Fernández-Carballido; Eugenio de Miguel; Sheila Melchor; Eva Salgado; Beatriz Bravo; Susana Romero-Yuste; Juan Salvatierra; Cristina Hidalgo; Sara Manrique; Carlos Romero-Gómez; Patricia Moya; Noelia Álvarez-Rivas; Javier Mendizabal; Francisco Ortiz-Sanjuán; Iván Pérez de Pedro; José L Alonso-Valdivielso; Laura Perez-Sanchez; Rosa Roldán; Nagore Fernandez-Llanio; Ricardo Gómez de la Torre; Silvia Suarez; María Jesús Montesa Cabrera; Mónica Delgado Sánchez; Javier Loricera; Belén Atienza-Mateo; Santos Castañeda; Miguel A González-Gay; Ricardo Blanco Journal: Ther Adv Musculoskelet Dis Date: 2021-06-18 Impact factor: 5.346