Lili Pan1, Juan Du1, Jiayi Liu2, Hua Liao1, Xiaoli Liu3, Xi Guo4, Jing Liang3, Hongya Han3, Lixia Yang3, Yujie Zhou5. 1. Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 2. Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 3. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China. 4. Department of Interventional Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 5. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China. azzyj12@163.com.
Abstract
OBJECTIVE: Coronary artery involvement in Takayasu arteritis (TAK) leads to poor prognosis and high mortality. Tocilizumab (TCZ) has been used to effectively treat large vessel vasculitis. However, the efficacy of TCZ in resolving coronary artery involvement in TAK is unclear. The aim of this retrospective study was to evaluate the efficacy of TCZ in the treatment of coronary artery involvement in TAK. METHODS: Clinical features and manifestations of coronary artery lesions in 11 TAK patients were evaluated before and after TCZ treatment, and the results were compared with those of 11 patients treated with traditional disease-modifying antirheumatic drugs (DMARDs). RESULTS: C-reactive protein (p = 0.006), erythrocyte sedimentation rate (ESR) (p = 0.011), and Kerr score (p = 0.007) were significantly decreased post-TCZ treatment for 6 months. The Indian Takayasu Clinical Activity Score (ITAS) 2010 (p = 0.019) and ITAS-A (p = 0.019) were significantly lower in patients treated with TCZ compared with those treated with traditional DMARDs. The glucocorticoid (GC) dose was tapered to 2.50 (0.00, 7.50) mg day-1 after TCZ treatment for 6 months, which was significantly lower than the GC dose after traditional DMARDs treatment [10.0 (5.00, 11.25) mg.day-1, (p = 0.033)]. After 6-month TCZ treatment, the total number of coronary artery lesions was reduced from 23 to 15 in 6 patients. Vascular wall thickening was remarkably improved in 2 lesions (in the ostia of the left main and right coronary arteries). CONCLUSION: TCZ may decrease the disease activity and improve coronary artery lesion in patients with TAK. Key Points • TCZ treatment significantly decreased the disease activity in TAK patients with coronary artery involvement. • TCZ treatment significantly reduces the dosage of GC. • TCZ treatment led to an improvement in imaging findings of TAK patients with coronary artery involvement.
OBJECTIVE:Coronary artery involvement in Takayasu arteritis (TAK) leads to poor prognosis and high mortality. Tocilizumab (TCZ) has been used to effectively treat large vessel vasculitis. However, the efficacy of TCZ in resolving coronary artery involvement in TAK is unclear. The aim of this retrospective study was to evaluate the efficacy of TCZ in the treatment of coronary artery involvement in TAK. METHODS: Clinical features and manifestations of coronary artery lesions in 11 TAKpatients were evaluated before and after TCZ treatment, and the results were compared with those of 11 patients treated with traditional disease-modifying antirheumatic drugs (DMARDs). RESULTS:C-reactive protein (p = 0.006), erythrocyte sedimentation rate (ESR) (p = 0.011), and Kerr score (p = 0.007) were significantly decreased post-TCZ treatment for 6 months. The Indian Takayasu Clinical Activity Score (ITAS) 2010 (p = 0.019) and ITAS-A (p = 0.019) were significantly lower in patients treated with TCZ compared with those treated with traditional DMARDs. The glucocorticoid (GC) dose was tapered to 2.50 (0.00, 7.50) mg day-1 after TCZ treatment for 6 months, which was significantly lower than the GC dose after traditional DMARDs treatment [10.0 (5.00, 11.25) mg.day-1, (p = 0.033)]. After 6-month TCZ treatment, the total number of coronary artery lesions was reduced from 23 to 15 in 6 patients. Vascular wall thickening was remarkably improved in 2 lesions (in the ostia of the left main and right coronary arteries). CONCLUSION:TCZ may decrease the disease activity and improve coronary artery lesion in patients with TAK. Key Points • TCZ treatment significantly decreased the disease activity in TAKpatients with coronary artery involvement. • TCZ treatment significantly reduces the dosage of GC. • TCZ treatment led to an improvement in imaging findings of TAKpatients with coronary artery involvement.