title: One-year clinical and radiological evolution of a patient with refractory Takayasu's arteritis under treatment with tocilizumab.
abstract: A 28-year-old patient with Takayasu's arteritis (TA) failed to respond to high doses of prednisone in combination with methotrexate, pulses of cyclophosphamide and methylprednisolone, azathioprine, mycophenolate mofetil, adalimumab and monthly infusions of infliximab 5 mg/kg. After the beginning of tocilizumab therapy (4-8 mg/kg at monthly infusions), an impressive improvement in clinical and laboratory parameters of disease activity occurred, allowing the reduction of prednisone dose from 30 to 5 mg/day. However, after the 8th dose the patient developed symptoms of vertebrobasilar insufficiency, despite maintaining a good clinical condition and normal values of inflammatory markers. Angio-computed tomography repeated at one year of therapy showed reduction in aortic wall thickness, but also narrowing of the luminal diameters of the right subclavian, renal arteries, and left vertebral artery. Therefore, despite a significant clinical and laboratory improvement, vascular disease may progress in aortic branches in TA patients under tocilizumab therapy.
authors.affiliation: Rheumatology Service of Hospital Nossa Senhora da Conceição - Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil. markbred@terra.com.br
authors.forename: Markus
authors.initials: M
authors.lastname: Bredemeier
authors.forename: Cláudia M
authors.initials: CM
authors.lastname: Rocha
authors.forename: Malu V
authors.initials: MV
authors.lastname: Barbosa
authors.forename: Eduardo H
authors.initials: EH
authors.lastname: Pitrez
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects; D018450:Disease Progression; D004334:Drug Administration Schedule; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018836:Inflammation Mediators / Q000097:blood; D007262:Infusions, Intravenous; D013625:Takayasu Arteritis / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D018836:Inflammation Mediators; C502936:tocilizumab