Session Type: Poster Session D
Session Time: 8:30AM-10:30AM
Background/Purpose: Tocilizumab (TCZ) has shown to be effective for large vessel vasculitis including Takayasu arteritis (TAK) (1-3). Most evidence in TAK comes from Asian patients. However, white patients seem to have different clinical and prognostic features.
Our aims were to: a) assess the efficacy and safety of TCZ in white patients with refractory TAK, b) determine if clinical improvement correlates with imaging outcomes, c) compare TCZ in monotherapy (TCZMONO) vs combined with conventional immunosuppressive drugs (TCZCOMBO).
Methods: Multicenter study of white patients with refractory TAK who received TCZ.Outcomes variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZMONO and TCZCOMBO was performed.
Results: 54 patients (46 women/8 men; median age 42.0 [32.5-50.5] years). TCZ was started after 12.0 [3.0-31.5] months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%) and 27/36 (75%) at 1, 3, 6 and 12 months, respectively. Prednisone dose was reduced from 30.0 [12.5-50.0] to 5.0 [0.0-5.6] mg/day at 12 months (Table). 10 (26.3%) of the 38 patients in whom an imaging follow-up test was performed showed no radiographic improvement after a median of 9.0 [6.0-14.0] months. 4 of them were in clinical remission.23 (42.6%) patients were on TCZMONO and 31 (57.4%) on TCZCOMBO: MTX (n=28), cyclosporine A (n=2), azathioprine (n=1). Patients on TCZCOMBO were younger (38.0 [27.0-46.0] vs 45 [38.0-57.0] years; p= 0.048), with a trend to longer TAK duration (21.0 [6.0-38.0] vs 6.0 [1.0-23.0] months; p= 0.08) and higher C-reactive protein (2.4 [0.7-5.6] vs 1.3 [0.3-3.3] mg/dL; p=0.16). Despite these differences, similar outcomes were observed in both groups (log rank p=0.862) (Figure). Relevant adverse events were reported in 6 (11.1%) patients, but only 3 developed severe events that required TCZ withdrawal.
Conclusion: TCZ is effective and safe in white patients with refractory TAK. A discordance between clinical and imaging activity assessment may exist.
- Prieto Peña D et al. Evidence for uncoupling of clinical and 18-FDG activity of PET/CT scan improvement in tocilizumab-treated patients with large-vessel giant cell arteritis. Clin Exp Rheumatol 2020 Nov 27. PMID: 33253103.
- Loricera J, et al. Tocilizumab in patients with Takayasu arteritis: a retrospective study and literature review. Clin Exp Rheumatol 2016; 34:S44-53. PMID: 27050507.
- Calderón-Goercke M, et al. Tocilizumab in Giant Cell Arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum 2019; 49:126-35. https://doi.org/10.1016/j.semarthrit.2019.01.003.
To cite this abstract in AMA style:Prieto-Peña D, Bernabeu P, Vela P, Narvaez J, Fernández-López J, Freire M, González-Alvarez B, Solans-Laqué R, Callejas J, Ortego N, Fernández-Díaz C, Rubio Romero E, Garcia-Morillo S, Minguez M, Carballido C, De Miguel E, Melchor S, Salgado E, Bravo B, Romero-Yuste S, Salvatierra J, Hidalgo C, Manrique Arija S, Romero Gomez C, Moya P, Álvarez-Rivas N, Mendizábal-Mateos J, Ortiz-Sanjuán F, Perez De Pedro I, Alonso-Valdivielso J, Perez-Sanchez L, Roldan R, Fernandez-Llanio N, Gómez de la Torre R, Suarez S, Montesa Cabrera M, DELGADO SANCHEZ M, Loricera J, Atienza-Mateo B, gonzalez-Gay M, Blanco R. Tocilizumab in Caucasian Patients with Takayasu Arteritis: Multicenter Study of 54 Patients [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/tocilizumab-in-caucasian-patients-with-takayasu-arteritis-multicenter-study-of-54-patients/. Accessed September 25, 2022.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tocilizumab-in-caucasian-patients-with-takayasu-arteritis-multicenter-study-of-54-patients/