Tocilizumab for the treatment of large‐vessel vasculitis (giant cell arteritis, Takayasu arteritis) and polymyalgia rheumatica

Arthritis Care and Research - Tập 64 Số 11 - Trang 1720-1729 - 2012
Sebastian Unizony1, L. Arias‐Urdaneta2, Eli M. Miloslavsky2, Sheila L. Arvikar2, Arezou Khosroshahi2, B. Keroack3, James R. Stone2, John H. Stone4
1Massachusetts General Hospital - Boston, USA
2Massachusetts General Hospital and Harvard Medical School, Boston
3Rheumatology Associates, Maine Medical Center, Portland, and Tufts University School of Medicine, Boston, Massachusetts
4Rheumatology Unit, Massachusetts General Hospital, 55 Fruit Street/Yawkey 2C, Boston, MA 02114

Tóm tắt

AbstractObjectiveThe interleukin‐6 pathway is up‐regulated in giant cell arteritis (GCA), Takayasu arteritis (TA), and polymyalgia rheumatica (PMR). We retrospectively assessed the outcomes of 10 patients with relapsing/refractory GCA, TA, or PMR treated with tocilizumab (TCZ).MethodsPatients with GCA (n = 7), TA (n = 2), and PMR (n = 1) received TCZ. Seven subjects had failed at least 1 second‐line agent. The outcomes evaluated were symptoms of disease activity, inflammatory markers, ability to taper glucocorticoids, and cross‐sectional imaging when indicated clinically.ResultsThe mean followup time of this cohort since diagnosis was 27 months (range 16–60 months). The patients were treated with TCZ for a mean period of 7.8 months (range 4–12 months). Before TCZ therapy, the patients experienced an average of 2.4 flares/year. All patients entered and maintained clinical remission during TCZ therapy. The mean daily prednisone dosages before and after TCZ initiation were 20.8 mg/day (range 7–34.3 mg/day) and 4.1 mg/day (range 0–10.7 mg/day), respectively (P = 0.0001). The mean erythrocyte sedimentation rate declined from 41.5 mm/hour (range 11–68 mm/hour) to 7 mm/hour (range 2.2–11.3 mm/hour; P = 0.0001). The adverse effects of TCZ included mild neutropenia (n = 4) and transaminitis (n = 4). One patient flared 2 months after TCZ discontinuation. An autopsy on 1 patient who died from a postoperative myocardial infarction following elective surgery revealed persistent vasculitis of large and medium‐sized arteries.ConclusionTCZ therapy led to clinical and serologic improvement in patients with refractory/relapsing GCA, TA, or PMR. The demonstration of persistent large‐vessel vasculitis at autopsy of 1 patient who had shown a substantial response requires close scrutiny in larger studies.

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Arthritis Care and Research

Tập 64 Số 11

1720-1729

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