Tocilizumab in Refractory Takayasu Arteritis. a Multicenter Study

Natalia Palmou¹, Montserrat Santos-Gómez^1,2, Javier Loricera¹, Ricardo Blanco¹, Jose L. Hernández³, Santos Castañeda⁴, Alicia Humbría⁵, Norberto Ortego-Centeno⁶, Beatriz Bravo⁷, Mercedes Freire^8,9, Sheila Melchor¹⁰, Mauricio Minguez¹¹, Juan Salvatierra¹², Carmen Gonzalez-Vela¹³, Vanesa Calvo-Río¹, Trinitario Pina¹ and Miguel Angel Gonzalez-Gay¹, ¹Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, ²Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Spain, Santander, Spain, ³Internal Medicine, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, ⁴Rheumatology, H.U. La Princesa, Madrid, Spain, ⁵Rheumatology, Hospital Universitario de La Princesa. IIS-Princesa, Madrid, Madrid, Spain, ⁶Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Granada, Spain, ⁷Pediatric rheumatology, Hospital Virgen de las Nieves, Granada, Spain, ⁸Rheumatology, Hospital Universitario Juan Canalejo, La Coruña, Spain, ⁹Rheumatology, Complejo Hospitalario Universitario de A Coruña, La Coruna, Spain, ¹⁰Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain, ¹¹Department of Rheumatology, Hospital Universitario San Juan, Alicante, Spain, ¹²Rheumatology, University Hospital San Cecilio, Granada, Spain, ¹³Pathology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Multicenter study, takayasu arteritis and tocilizumab

Session Information

Date: Tuesday, November 10, 2015

Title: Vasculitis Poster III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Takayasu arteritis (TA) is often refractory to corticosteroids and traditional immunosuppressive agents. Interleukin (IL)-6 plays an important role in the pathogenesis of TA. Tocilizumab (TCZ) is a humanized monoclonal anti-IL6 receptor (IL-6R) antibody.

Objective: Our aim was to assess the efficacy of TCZ in patients with TA refractory to conventional treatment.

Methods:

Retrospective multicenter study of 8 patients treated with TCZ and diagnosed with TA refractory to conventional therapy. We assessed its efficacy (clinical and laboratory parameters) and the reduction in the corticosteroid dose, as well as its side effects. Comparisons were performed between baseline and 1^st, 3^rd, 6^th and 12^th months, by means of

Results:

Eight patients (all women) with a mean age of 34±16 years, median 36 years (range: 7-57) were assessed. The main clinical features at TCZ therapy onset were: constitutional symptoms (n=4), fever (n=3), headache (n=2), chest pain (n=1), abdominal pain (n=1), mesenteric ischemia (n=1), myalgia involving the lower limbs (n=1), cerebral vascular insufficiency (n=1), malaise (n=1), upper limb claudication (n=1) and nodular scleritis (n=1). Besides corticosteroids and before TCZ treatment onset, 7 of 8 patients had also received several conventional immunosuppressive and/or biologic agents. Seven patients experienced marked clinical improvement in the first 3 months after the onset of TCZ therapy. After a median follow-up of 15.5 [interquartile range-IQR: 12-24] months, 7 patients were asymptomatic. The median C-reactive protein decreased from 3.09 [IQR: 0.5-12] to 0.15 [ IQR: 0.1-0.5] mg/dL (p= 0.018), and median erythrocyte sedimentation rate from 40 [IQ range: 28-72] to 3 [IQR: 2-5] mm/1^st hour (p= 0.012). The median dose of prednisone was also tapered from 42.5 [IQR: 25-50] to 2.5 [IQR: 0-7.5] mg/day (p= 0.011). However, TCZ had to be discontinued in 1 patient because she developed a systemic lupus erythematosus, and in another patients due to inefficiency. TCZ dose was reduced in a patient because of mild thrombocytopenia.

Conclusion:

TCZ appears to be effective in the management of patients with TakA, in particular in patients refractory to corticosteroids and/or conventional immunosuppressive drugs.

Disclosure: N. Palmou, None; M. Santos-Gómez, None; J. Loricera, None; R. Blanco, None; J. L. Hernández, None; S. Castañeda, None; A. Humbría, None; N. Ortego-Centeno, None; B. Bravo, None; M. Freire, None; S. Melchor, None; M. Minguez, None; J. Salvatierra, None; C. Gonzalez-Vela, None; V. Calvo-Río, None; T. Pina, None; M. A. Gonzalez-Gay, None.

To cite this abstract in AMA style:

Palmou N, Santos-Gómez M, Loricera J, Blanco R, Hernández JL, Castañeda S, Humbría A, Ortego-Centeno N, Bravo B, Freire M, Melchor S, Minguez M, Salvatierra J, Gonzalez-Vela C, Calvo-Río V, Pina T, Gonzalez-Gay MA. Tocilizumab in Refractory Takayasu Arteritis. a Multicenter Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/tocilizumab-in-refractory-takayasu-arteritis-a-multicenter-study/. Accessed .

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