Therapeutic Advances in Musculoskeletal Disease (Jun 2021)

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

  • Diana Prieto-Peña,
  • Pilar Bernabeu,
  • Paloma Vela,
  • Javier Narváez,
  • Jesús C. Fernández-López,
  • Mercedes Freire-González,
  • Beatriz González-Álvarez,
  • Roser Solans-Laqué,
  • José L. Callejas Rubio,
  • Norberto Ortego,
  • Carlos Fernández-Díaz,
  • Esteban Rubio,
  • Salvador García-Morillo,
  • Mauricio Minguez,
  • Cristina Fernández-Carballido,
  • Eugenio de Miguel,
  • Sheila Melchor,
  • Eva Salgado,
  • Beatriz Bravo,
  • Susana Romero-Yuste,
  • Juan Salvatierra,
  • Cristina Hidalgo,
  • Sara Manrique,
  • Carlos Romero-Gómez,
  • Patricia Moya,
  • Noelia Álvarez-Rivas,
  • Javier Mendizabal,
  • Francisco Ortiz-Sanjuán,
  • Iván Pérez de Pedro,
  • José L. Alonso-Valdivielso,
  • Laura Perez-Sanchez,
  • Rosa Roldán,
  • Nagore Fernandez-Llanio,
  • Ricardo Gómez de la Torre,
  • Silvia Suarez,
  • María Jesús Montesa Cabrera,
  • Mónica Delgado Sánchez,
  • Javier Loricera,
  • Belén Atienza-Mateo,
  • Santos Castañeda,
  • Miguel A. González-Gay,
  • Ricardo Blanco

DOI
https://doi.org/10.1177/1759720X211020917
Journal volume & issue
Vol. 13

Abstract

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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 MONO ) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZ COMBO ) 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 MONO and 31 (57.4%) on TCZ COMBO : MTX ( n = 28), cyclosporine A ( n = 2), azathioprine ( n = 1). Patients on TCZ COMBO 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.