title: Corticosteroid-free treatment of tocilizumab monotherapy for microscopic polyangiitis: a single-arm, single-center, clinical trial.
abstract: OBJECTIVE
  To assess the efficacy of tocilizumab (TCZ) monotherapy for the remission induction of microscopic polyangiitis (MPA) in a prospective single-arm, single-center, cohort, pilot study.
  
  
  METHODS
  Eligible patients were aged between 20 and 80 years and were newly diagnosed with MPA according to Watts' classification algorithm. Seven patients received 8 mg/kg of intravenous TCZ fortnightly for the first 2 months (5 courses), and monthly for the next 10 months (10 courses). One year after TCZ monotherapy, the patients were followed-up without any treatment. The protocol did not permit the use corticosteroids or any other immunosuppressants. Complete remission (CR) was defined as the Birmingham Vasculitis Activity Score of 0 at two consecutive visits made at least a month apart.
  
  
  RESULTS
  CR was achieved in two of six patients (33.3%) at 6 months and three patients (50.0%) at 12 months. Two patients were withdrawn: one because of inefficacy at 6 weeks and the other because of flare at 6 months. One patient voluntarily withdrew after CR at 3 months. Four patients (66.7%) could be kept drug-free after 1 year of TCZ without relapse for 6-15 months at the last visit.
  
  
  CONCLUSIONS
  TCZ monotherapy may be an alternative treatment strategy in some patients with MPA.
authors.affiliation: a Department of Rheumatology and Clinical Immunology , Saitama Medical Center, Saitama Medical University , Kawagoe , Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Sakai
authors.affiliation: a Department of Rheumatology and Clinical Immunology , Saitama Medical Center, Saitama Medical University , Kawagoe , Japan.
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Kondo
authors.affiliation: a Department of Rheumatology and Clinical Immunology , Saitama Medical Center, Saitama Medical University , Kawagoe , Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kikuchi
authors.affiliation: a Department of Rheumatology and Clinical Immunology , Saitama Medical Center, Saitama Medical University , Kawagoe , Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Shibata
authors.affiliation: a Department of Rheumatology and Clinical Immunology , Saitama Medical Center, Saitama Medical University , Kawagoe , Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Chino
authors.affiliation: a Department of Rheumatology and Clinical Immunology , Saitama Medical Center, Saitama Medical University , Kawagoe , Japan.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Okuyama
authors.affiliation: a Department of Rheumatology and Clinical Immunology , Saitama Medical Center, Saitama Medical University , Kawagoe , Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Takei
authors.affiliation: a Department of Rheumatology and Clinical Immunology , Saitama Medical Center, Saitama Medical University , Kawagoe , Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Amano
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D055953:Microscopic Polyangiitis / Q000188:drug therapy*; D008875:Middle Aged
chemical_list: D000305:Adrenal Cortex Hormones; D061067:Antibodies, Monoclonal, Humanized; C502936:tocilizumab
keywords: Antineutrophil cytoplasmic antibody; Microscopic polyangiitis; Tocilizumab; Vasculitis