title: Treatment of refractory Takayasu arteritis with tocilizumab: 7 Italian patients from a single referral center.
abstract: OBJECTIVE
  The aim of our study was to evaluate the safety and the efficacy of tocilizumab (TCZ) for refractory Takayasu arteritis (TA).
  
  
  METHODS
  We retrospectively assessed the outcome of blocking interleukin (IL)-6 with TCZ in 7 consecutive patients with refractory TA using a combination of clinical and imaging assessment.
  
  
  RESULTS
  During a median followup visit at 14 months, 4 patients taking TCZ [including 2 nonresponders to tumor necrosis factor (TNF) inhibitors] achieved clinical response, suggesting a nonredundant role for IL-6 in TA. Inflammatory markers normalized in all patients treated with TCZ. However, vascular progression occurred in 4 patients, suggesting the involvement of other inflammatory pathways and confirming the limitations of erythrocyte sedimentation rate and C-reactive protein for disease activity assessment while taking TCZ. Three patients experienced adverse events and 2 suspended TCZ.
  
  
  CONCLUSIONS
  TCZ may be effective in a subset of patients with refractory TA, even in cases of unresponsiveness to TNF inhibitors. Inflammatory markers are not valid markers of TA activity on TCZ. Further studies are needed to confirm these preliminary observations.
authors.affiliation: From the Unit of Internal Medicine and Immunology, and the Unit of Radiology, San Raffaele University Hospital, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Tombetti
authors.forename: Stefano
authors.initials: S
authors.lastname: Franchini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Papa
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Sabbadini
authors.forename: Elena
authors.initials: E
authors.lastname: Baldissera
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging; D012017:Referral and Consultation; D012189:Retrospective Studies; D013625:Takayasu Arteritis / Q000188:drug therapy* / Q000473:pathology*; D016896:Treatment Outcome; D055815:Young Adult; D000093242:Interleukin-6 Inhibitors; D015850:Interleukin-6
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000093242:Interleukin-6 Inhibitors; C508600:IL6 protein, human; D015850:Interleukin-6; C502936:tocilizumab
keywords: INTERLEUKIN 6; TAKAYASU ARTERITIS; TOCILIZUMAB; VASCULITIS