title: Tocilizumab in glucocorticoid-naïve large-vessel vasculitis.
abstract: Glucocorticoids (GC) are the mainstay of treatment of large-vessel vasculitis (LVV), but a sizeable number of patients relapse upon tapering the GC dose or after discontinuation of GC therapy. In addition, GC cause numerous adverse events. Therefore, in patients with longstanding disease and in those at risk for GC-related adverse events, the use of alternative therapeutic agents should be considered. Interleukin-6 (IL-6) is a key player in the pathogenesis of LVV. Preliminary data suggest the efficacy of the IL-6 receptor inhibitor tocilizumab (TCZ) in patients with LVV. We report 2 treatment-naïve patients with a recent diagnosis of LVV who received monthly TCZ infusions (8 mg/kg body weight) for 6 consecutive months as monotherapy because of relative contraindications and patients' reluctance to take GC. In both cases we observed a complete clinical response and normalisation of inflammatory markers as well as a decrease in vascular FDG uptake and SUV ratio on fluorodeoxyglucose positron emission/computerised tomography. Serum IL-6 and soluble IL-6 receptor (sIL-6R) levels rose in both patients after TCZ therapy. TCZ may be an effective alternative to GC treatment for LVV patients at risk for GC-related adverse events. Larger studies are required to confirm our findings.
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pazzola
authors.forename: I
authors.initials: I
authors.lastname: Padovano
authors.forename: L
authors.initials: L
authors.lastname: Boiardi
authors.forename: A
authors.initials: A
authors.lastname: Versari
authors.forename: N
authors.initials: N
authors.lastname: Pipitone
authors.forename: M
authors.initials: M
authors.lastname: Catanoso
authors.forename: L
authors.initials: L
authors.lastname: Pulsatelli
authors.forename: R
authors.initials: R
authors.lastname: Meliconi
authors.forename: C
authors.initials: C
authors.lastname: Salvarani
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors / Q000097:blood; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014657:Vasculitis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D015415:Biomarkers; C508600:IL6 protein, human; C508603:IL6R protein, human; D007166:Immunosuppressive Agents; D018836:Inflammation Mediators; D015850:Interleukin-6; D019947:Receptors, Interleukin-6; C502936:tocilizumab