title: Rescue treatment with tocilizumab for Takayasu arteritis resistant to TNF-α blockers.
abstract: Anti-TNF-α therapy has successfully been used to treat Takayasu arteritis (TA) refractory to conventional immunosuppressive treatment. However, some patients fail to respond even to TNF-α blockers. Interleukin-6 (IL-6) is a key player in the pathogenesis of TA. Preliminary data also suggest efficacy of the IL-6 receptor inhibitor tocilizumab in patients with large-vessel vasculitis. We report a patient with TA refractory to multiple conventional immunosuppressive agents and two TNF-α blockers successfully treated with monthly tocilizumab infusions (8 mg/kg body weight) for 6 consecutive months. Clinical indices of disease activity, inflammatory markers, and 18Ffluorodeoxyglucose positron emission/computerised tomography findings normalised, while the prednisone dosage could be tapered. Serum IL-6 and soluble IL-6 receptor (sIL-6R) levels raised during tocilizumab treatment consistent with the mode of action of tocilizumab. Tocilizumab holds promise for patients with refractory TA. Larger studies are required to confirm our findings.
authors.affiliation: Rheumatology Unit, Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy. salvarani.carlo@asmn.re.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Salvarani
authors.forename: Luca
authors.initials: L
authors.lastname: Magnani
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Catanoso
authors.forename: Nicolò
authors.initials: N
authors.lastname: Pipitone
authors.forename: Annibale
authors.initials: A
authors.lastname: Versari
authors.forename: Lucia
authors.initials: L
authors.lastname: Dardani
authors.forename: Lia
authors.initials: L
authors.lastname: Pulsatelli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Meliconi
authors.forename: Luigi
authors.initials: L
authors.lastname: Boiardi
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D057176:Compassionate Use Trials; D004334:Drug Administration Schedule; D004351:Drug Resistance; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D018836:Inflammation Mediators / Q000097:blood; D007262:Infusions, Intravenous; D015850:Interleukin-6 / Q000097:blood; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors* / Q000097:blood; D016879:Salvage Therapy; D013625:Takayasu Arteritis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000097:blood; D051598:Whole Body Imaging
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C508600:IL6 protein, human; C508603:IL6R protein, human; D007166:Immunosuppressive Agents; D018836:Inflammation Mediators; D015850:Interleukin-6; D019275:Radiopharmaceuticals; D019947:Receptors, Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D019788:Fluorodeoxyglucose F18; C502936:tocilizumab