Tocilizumab in refractory Caucasian Takayasu's arteritis : a multicenter study of 54 patients and literature review

Tocilizumab in refractory Caucasian Takayasu's arteritis : a multicenter study of 54 patients and literature review

Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu's arteritis (TAK) in clinical practice. Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-...

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Hauptverfasser: Prieto-Peña, Diana, Bernabeu, Pilar, Vela, Paloma, Narváez, Javier, Fernández-López, Jesus C, Freire-González, Mercedes, González-Álvarez, Beatriz, Solans, Roser, Callejas Rubio, Jose Luis, Ortego, Norberto, Fernández-Díaz, Carlos, Rubio, Esteban, García-Morillo, Salvador, Minguez, Mauricio, Fernández-Carballido, Cristina, de Miguel, Eugenio, Melchor, Sheila, Salgado, Eva, Bravo, Beatriz, Romero-Yuste, Susana, Salvatierra, Juan, Hidalgo, Cristina, Manrique, Sara, Romero-Gómez, Carlos, Moya, Patricia, Álvarez-Rivas, Noelia, Mendizabal, Javier, Ortiz-Sanjuán, Francisco, Pérez de Pedro, Iván, Alonso-Valdivielso, José L, Perez-Sanchez, Laura, Roldán, Rosa, Fernandez-Llanio, Nagore, Gómez de la Torre, Ricardo, Suarez, Silvia, Montesa Cabrera, María Jesús, Delgado Sánchez, Mónica, Loricera, Javier, Atienza-Mateo, Belén, Castañeda, Santos, Gonzalez-Gay, MA, Blanco, Ricardo
Format: Artikel
Sprache:eng
Schlagworte:
Biological therapy
Caucasian
Cdmards
Takayasu's arteritis
Tocilizumab
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Zusammenfassung:Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu's arteritis (TAK) in clinical practice. Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZ) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZ) was performed. Results: The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42.0 (32.5-50.5) years. TCZ was started after a median (IQR) of 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%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30.0 mg/day (12.5-50.0) to 5.0 (0.0-5.6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73.7%) patients after a median (IQR) of 9.0 (6.0-14.0) months. Twenty-three (42.6%) patients were on TCZ and 31 (57.4%) on TCZ: MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZ were younger [38.0 (27.0-46.0) versus 45.0 (38.0-57.0)] years; difference (diff) [95% confidence interval (CI) = -7.0 (-17.9, -0.56] with a trend to longer TAK duration [21.0 (6.0-38.0) versus 6.0 (1.0-23.0)] months; diff 95% CI = 15 (-8.9, 35.5), and higher c-reactive protein [2.4 (0.7-5.6) versus 1.3 (0.3-3.3)] mg/dl; diff 95% CI = 1.1 (-0.26, 2.99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0.862). Relevant adverse events were reported in six (11.1%) patients, but only three developed severe events that required TCZ withdrawal. Conclusion: TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin.