Paul Decker1, Pierre Olivier2, Jessie Risse1, Stéphane Zuily3, Denis Wahl4. 1. Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, Hôpitaux de Brabois, CHRU de Nancy, 5 rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France. 2. University of Lorraine, Nancy, France; Department of Nuclear Medicine, Hôpitaux de Brabois, CHRU de Nancy, 5 rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France. 3. Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, Hôpitaux de Brabois, CHRU de Nancy, 5 rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France; University of Lorraine, Nancy, France; INSERM UMR_S 1116, Vandoeuvre-lès-Nancy, France. 4. Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, Hôpitaux de Brabois, CHRU de Nancy, 5 rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France; University of Lorraine, Nancy, France; INSERM UMR_S 1116, Vandoeuvre-lès-Nancy, France. Electronic address: d.wahl@chru-nancy.fr.
Abstract
BACKGROUND: Relapses upon corticosteroids tapering and immunosuppressive agents are frequent in Takayasu arteritis (TA). Interleukin-6 is highly involved in physiopathology of TA. Many reports showed efficacy of tocilizumab (TCZ) in refractory TA cases. We report four cases and an updated literature review on the TCZ efficacy and safety in patients with TA. METHODS: Patients with TA defined by ACR 1990 criteria were included. Clinical, biological and imaging data were retrospectively reported. Disease activity was analyzed before TCZ and during the follow-up. Medline database was searched for systematic literature review. RESULTS: One hundred and five patients (median age 28years [22-38]) were included, mostly refractory cases (76 patients, 72%). Median TCZ duration was 12months [6-20]. Among 105 patients, 90 patients (85.7%) had an initial clinical response within three months [3-6] and 43/66 patients (65.2%) had a radiological improvement. Only seven patients (9%) showed relapse on therapy. Corticosteroid dose reduction was obtained in 75/83 patients (90.4%). Relapse after TCZ discontinuation was observed in six patients (46%), with a median time of five months [2-9]. Twenty-four side-effects were noted in 18 patients (18%), with TCZ interruption in seven cases (7%): 10 infections, five cytopenia, six hepatitis, one pancreatitis, one cutaneous rash and one breast cancer. CONCLUSIONS: This review confirms that TCZ is safe and effective in refractory cases of TA and TCZ is a corticosteroid-sparing therapy in patients with or without previous TNFα blockers therapy. However relapses after TCZ discontinuation are frequent.
BACKGROUND: Relapses upon corticosteroids tapering and immunosuppressive agents are frequent in Takayasu arteritis (TA). Interleukin-6 is highly involved in physiopathology of TA. Many reports showed efficacy of tocilizumab (TCZ) in refractory TA cases. We report four cases and an updated literature review on the TCZ efficacy and safety in patients with TA. METHODS:Patients with TA defined by ACR 1990 criteria were included. Clinical, biological and imaging data were retrospectively reported. Disease activity was analyzed before TCZ and during the follow-up. Medline database was searched for systematic literature review. RESULTS: One hundred and five patients (median age 28years [22-38]) were included, mostly refractory cases (76 patients, 72%). Median TCZ duration was 12months [6-20]. Among 105 patients, 90 patients (85.7%) had an initial clinical response within three months [3-6] and 43/66 patients (65.2%) had a radiological improvement. Only seven patients (9%) showed relapse on therapy. Corticosteroid dose reduction was obtained in 75/83 patients (90.4%). Relapse after TCZ discontinuation was observed in six patients (46%), with a median time of five months [2-9]. Twenty-four side-effects were noted in 18 patients (18%), with TCZ interruption in seven cases (7%): 10 infections, five cytopenia, six hepatitis, one pancreatitis, one cutaneous rash and one breast cancer. CONCLUSIONS: This review confirms that TCZ is safe and effective in refractory cases of TA and TCZ is a corticosteroid-sparing therapy in patients with or without previous TNFα blockers therapy. However relapses after TCZ discontinuation are frequent.
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