ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1989

Treatment of Refractory Non-Infectious Aortitis: Tocilizumab Compared to Antitnf Alfa Agents. Multicenter Study of 44 Patients

Montserrat Santos-Gómez1, Javier Loricera1, Ricardo Blanco1, Jose L. Hernández2, Santos Castañeda3, Norberto Ortego-Centeno4, M. Enriqueta Peiró1, Paz Collado5, Sheila Melchor6, Antonio Mera7, Eva Pérez-Pampin8, Esteban Rubio Romero9, Jaime Calvo-Alen10, Elena Aurrecoechea11, Iñigo Rúa-Figueroa12, Mauricio Minguez13, Gabriel Herrero-Beaumont14, Beatriz Bravo15, José Rosas16, Javier Narváez17, Javier Calvo18, Rafael Ariza-Ariza19, Mercedes Freire20, Pablo Lluch Mesquida21, Cristina Mata22, Eva Galindez-Agirregoikoa23, Juan María Blanco Madrigal23, Amalia Sánchez24, José Salvatierra25, Vanesa Calvo-Río1, Carmen Gonzalez-Vela26, Natalia Palmou1, Leyre Riancho-Zarrabeitia1 and Miguel Angel Gonzalez-Gay1, 1Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, 2Internal Medicine, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, 3Rheumatology, Hospital Universitario de la Princesa, Madrid, Spain, 4Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Granada, Spain, 5Rheumatology, Pediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain, 6Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain, 7Hospital Universitario de Santiago de Compostela, La Coruña, Spain, 8Rheumatology, Hospital Universitario de Santiago de Compostela, La coruña, Spain, 9Rheumatology Department,, Hospital Universitario Virgen del Rocío, Sevilla, Spain, 10Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain, 11Rheumatology, Hospital de Sierrallana, Torrelavega, Spain, 12Rheumatology, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canarias, Spain, 13Department of Rheumatology, Hospital Universitario San Juan, Alicante, Spain, 14Department of Osteoarticular Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain, 15Pediatric rheumatology, Hospital Virgen de las Nieves, Granada, Spain, 16Rheumatology, Hospital Marina Baixa, Villajoyosa, Spain, 17Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain, 18Rheumatology, Hospital General Consorcio de Valencia, Valencia, Spain, 19Rheumatology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain, 20Rheumatology, Complejo Hospitalario Universitario de A Coruña, La Coruna, Spain, 21Hospital Mateu Orfila, Mahón (Menorca), Spain, 22Rheumatology, Hospital de Sierrallana, Laredo, Spain, 23Rheumatology, Hospital Universitario de Basurto, Bilbao, Spain, 24Hospital Lucus Augusti, Lugo, Spain, 25Hospital Universitario de San Cecilio, Granada, Spain, 26Pathology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: ,

Session Information

Date: Monday, November 9, 2015

Title: Vasculitis Poster II

Session Type: ACR Poster Session B

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

Background/Purpose:  

 Aortitis is often refractory to conventional immunosuppressive (IS) therapy. The use of biological therapy, such as tocilizumab (TCZ) and anti-TNFα agents have been reported.

 Our aim was to compare the efficacy of TCZ with anti-TNFα therapy in patients with aortitis.

Methods:

Retrospective multicenter study of patients with aortitis refractory to traditional IS agents.

Results:

We studied 44 patients (36 W/8 M; 51±19 years); 25 with TCZ and 19 with anti-TNFα agents (IFX=14, ADA=3, and ETN=2). Baseline features of patients on TCZ compared to the anti-TNFα group (always in this order) showed a) mean age: 58±20 vs 42±13 years (p=0.003), b) women: 84% vs 79%, (p=0.97), c) underlying conditions: Takayasu arteritis, 8 vs 11 cases (p=0.08); giant cell arteritis, 15 vs 2 (p=0.0025); relapsing polychondritis, 1 vs 1 (p=0.59); ulcerative colitis, 0 vs 1 (p=0.88); Crohn’s disease, 0 vs 1 (p=0.88); Behçet’s disease, 0 vs 1 (p=0.88); sarcoidosis, 0 vs 1 (p=0.88); psoriatic arthritis, 0 vs 1 (p=0.88); and idiopathic aortitis, 1 vs 0 (p=0.88) d) mean of previous traditional IS agents (1.1 vs 1.7, p=0.069) and biological therapies (0.3 vs 0.1, p=0.23). After 3 months of treatment, most patients in both groups had experienced a clinical and acute phase reactants improvement, as well as a reduction of the corticosteroid dose. This favourable response was maintained over time (Table). The improvement observed by imaging techniques was similar in both groups. After a median follow-up of 12 [9-17] vs 16 [12-36] months (p=0.014), TCZ was withdrawn due to severe neutropenia (n=1); recurrent pneumonia (n=1); cytomegalovirus infection (n=1) and systemic lupus erythematosus (n=1). Other adverse effects were thrombocytopenia (n=1) and infusional hypotension (n=1). One patient died due to a stroke in the setting of an infective endocarditis, and another one discontinued TCZ because of inefficacy. In the anti-TNFα group, 3 patients on IFX discontinued due to inefficacy (n=1), recurrent pneumonia (n=1) and severe infusional reaction (n=1).

Conclusion:

Biological therapy appears effective and relatively safe in patients with aortitis refractory to traditional IS drugs. In this series, TCZ seems to be slightly more effective than anti-TNFα agents.

TABLE

TCZ (n= 25)

anti-TNFα (n= 19)

p

Partial clinical improvement N; % #

At 3 months

22; 88% (25)

10; 55% (18)

0.09

At 6 months

18; 90% (20)

11; 69% (16)

0.022

At 12 months

15; 100%) (15)

15; (94%) (16)

0.97

CRP, median [IQR]

At onset

2.8 [0.8-5.4] (24)

1.5 [0.1-2.6] (15)

–

At 3 months

0.1 [0.1-0.6] (23)

0.1 [0.1-0.5] (12)

0.65

At 6 months

0.1 [0.1-0.5] (19)

0.3 [0.1-0.9] (12)

0.52

At 12 months

0.1 [0.1-0.5] (15)

0.2 [0.1-0.6] (11)

0.87

ESR, median [IQR]

At onset

43 [16-72] (23)

37.5 [30-56] (14)

–

At 3 months

7 [2-11] (21)

17.5 [9-25] (14)

0.22

At 6 months

4 [2-7] (15)

16 [9-20] (13)

0.020

At 12 months

6 [2-11] (11)

16 [11-18] (13)

0.027

Improvement by imaging

(between 3-6 months)

11; 73% (15)

10; 77% (13)

0.18

Prednisone dose, median [IQR]

At onset

25 [10-50] (24)

20 [5-50] (17)

–

At 3 months

10 [7.5-20] (25)

12.5 [5-20] (15)

0.28

At 6 months

5 [2.5-10] (19)

10 [5-10] (16)

0.043

At 12 months

2.5 [0-5] (15)

7.5 [5-10] (16)

0.003

# Improvement in at least one clinical manifestation.

In brackets, the number of patients with available data.

For CRP, ESR and prednisone daily requirement, “p” refers to the percentage of improvement at 3, 6 and 12 months compared to baseline (TCZ vs. anti–TNF)

Disclosure: M. Santos-Gómez, None; J. Loricera, None; R. Blanco, None; J. L. Hernández, None; S. Castañeda, None; N. Ortego-Centeno, None; M. E. Peiró, None; P. Collado, None; S. Melchor, None; A. Mera, None; E. Pérez-Pampin, None; E. Rubio Romero, None; J. Calvo-Alen, None; E. Aurrecoechea, None; I. Rúa-Figueroa, None; M. Minguez, None; G. Herrero-Beaumont, None; B. Bravo, None; J. Rosas, None; J. Narváez, None; J. Calvo, None; R. Ariza-Ariza, None; M. Freire, None; P. Lluch Mesquida, None; C. Mata, None; E. Galindez-Agirregoikoa, None; J. M. Blanco Madrigal, None; A. Sánchez, None; J. Salvatierra, None; V. Calvo-Río, None; C. Gonzalez-Vela, None; N. Palmou, None; L. Riancho-Zarrabeitia, None; M. A. Gonzalez-Gay, None.

To cite this abstract in AMA style:

Santos-Gómez M, Loricera J, Blanco R, Hernández JL, Castañeda S, Ortego-Centeno N, Peiró ME, Collado P, Melchor S, Mera A, Pérez-Pampin E, Rubio Romero E, Calvo-Alen J, Aurrecoechea E, Rúa-Figueroa I, Minguez M, Herrero-Beaumont G, Bravo B, Rosas J, Narváez J, Calvo J, Ariza-Ariza R, Freire M, Lluch Mesquida P, Mata C, Galindez-Agirregoikoa E, Blanco Madrigal JM, Sánchez A, Salvatierra J, Calvo-Río V, Gonzalez-Vela C, Palmou N, Riancho-Zarrabeitia L, Gonzalez-Gay MA. Treatment of Refractory Non-Infectious Aortitis: Tocilizumab Compared to Antitnf Alfa Agents. Multicenter Study of 44 Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/treatment-of-refractory-non-infectious-aortitis-tocilizumab-compared-to-antitnf-alfa-agents-multicenter-study-of-44-patients/. Accessed .

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