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

• Published in: Therapeutic advances in musculoskeletal disease Vol. 13; p. 1759720X211020917
• Main Authors: Prieto-Peña, Diana, Bernabeu, Pilar, Vela, Paloma, Narváez, Javier, Fernández-López, Jesús C., Freire-González, Mercedes, González-Álvarez, Beatriz, Solans-Laqué, Roser, Callejas Rubio, José L., 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, González-Gay, Miguel A., Blanco, Ricardo
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 2021; SAGE PUBLICATIONS, INC; SAGE Publishing
• Subjects: Biological products; C-reactive protein; Clinical outcomes; Immunotherapy; Monoclonal antibodies; Original Research; Patient safety; Vein & artery diseases; White people; Caucasian; cDMARDs; Takayasu’s arteritis; Tocilizumab; biological therapy
• ISSN: 1759-720X; 1759-7218; 1759-7218
• DOI: 10.1177/1759720X211020917

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 (TCZMONO) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZCOMBO) 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 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) 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.