title: Tocilizumab for the treatment of patients with refractory Takayasu arteritis.
abstract: Treatment of refractory Takayasu arteritis (TA) remains an unresolved clinical issue. Patients usually respond to glucocorticoid (GC) therapy, but often relapse on tapering of the GC dose. The aim of the present study was to assess the safety and efficacy of the interleukin-6 (IL-6) receptor antibody tocilizumab (TCZ) in patients with TA refractory to conventional therapies including GC. Four patients with TA who had shown GC resistance received TCZ infusions (8 mg/kg) every 4 weeks a total of at least 24 times (range, 24 to 51). Clinical symptoms, the serum levels of acute phase proteins and IL-6, GC dosage necessary to maintain remission, and cross-sectional imaging by enhanced CT and MRI were assessed. All patients achieved good clinical response and rapid normalization of the acute phase proteins such as C-reactive protein and serum amyloid A during the therapy with TCZ. The mean dosage of prednisolone could be reduced from 21.3 mg/day to 1.5 mg/day. Although the serum IL-6 level was transiently elevated in all patients after several TCZ infusions, it gradually recovered to the initial level. Along with the decrease of serum IL-6, two patients exhibited significant reduction in thickened arterial lesions. No drug-related adverse effects were noted. In this small group of patients with refractory TA, TCZ therapy was effective and well-tolerated. Further larger studies should be conducted to confirm this finding.
authors.affiliation: Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Nakaoka
authors.forename: Kaori
authors.initials: K
authors.lastname: Higuchi
authors.forename: Yoh
authors.initials: Y
authors.lastname: Arita
authors.forename: Michio
authors.initials: M
authors.lastname: Otsuki
authors.forename: Kaori
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hashimoto-Kataoka
authors.forename: Taku
authors.initials: T
authors.lastname: Yasui
authors.forename: Kuniyasu
authors.initials: K
authors.lastname: Ikeoka
authors.forename: Tomohito
authors.initials: T
authors.lastname: Ohtani
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sakata
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Shima
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kumanogoh
authors.forename: Keiko
authors.initials: K
authors.lastname: Yamauchi-Takihara
authors.forename: Toshio
authors.initials: T
authors.lastname: Tanaka
authors.forename: Tadamitsu
authors.initials: T
authors.lastname: Kishimoto
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors*; D013625:Takayasu Arteritis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D019947:Receptors, Interleukin-6; C502936:tocilizumab