title: Tocilizumab in patients with Takayasu arteritis: a retrospective study and literature review.
abstract: OBJECTIVE
  To assess the efficacy of tocilizumab (TCZ) in patients with Takayasu arteritis (TA).
  
  
  METHODS
  Multicentre open-label retrospective study.
  
  
  RESULTS
  Eight patients (all women) with a mean age of 34±16 years, median 36 years (range: 7-57) were assessed. The main clinical features at TCZ therapy onset were: constitutional symptoms (n=4), fever (n=3), headache (n=2), chest pain (n=1), abdominal pain (n=1), mesenteric ischaemia (n=1), myalgia involving the lower limbs (n=1), cerebral vascular insufficiency (n=1), malaise (n=1), upper limb claudication (n=1) and nodular scleritis (n=1). Besides corticosteroids and before TCZ treatment onset, 7 of 8 patients had also received several conventional immunosuppressive and/or biologic agents. Seven patients experienced marked clinical improvement in the first 3 months after the onset of TCZ therapy. After a median follow-up of 15.5 [interquartile range-IQR: 12-24] months, 7 patients were asymptomatic. The median C-reactive protein decreased from 3.09 [IQR: 0.5-12] to 0.15 [IQR: 0.1-0.5] mg/dL (p=0.018), and median erythrocyte sedimentation rate from 40 [IQ range: 28-72] to 3 [IQR: 2-5] mm/1st hour (p=0.012). The median dose of prednisone was also tapered from 42.5 [IQR: 25-50] to 2.5 [IQR: 0-7.5] mg/day (p=0.011). However, TCZ had to be discontinued in 1 patient because she developed a systemic lupus erythematosus, and in another patient due to inefficiency. TCZ dose was reduced in a patient because of mild thrombocytopenia.
  
  
  CONCLUSIONS
  TCZ appears to be effective in the management of patients with TA, in particular in patients refractory to corticosteroids and/or conventional immunosuppressive drugs.
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Loricera
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Blanco
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: Hernández
authors.affiliation: Department of Rheumatology, Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain.
authors.forename: Santos
authors.initials: S
authors.lastname: Castañeda
authors.affiliation: Department of Rheumatology, Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Humbría
authors.affiliation: Department of Autoimmune Diseases, Hospital San Cecilio, Granada, Spain.
authors.forename: Norberto
authors.initials: N
authors.lastname: Ortego
authors.affiliation: Unit of Paediatric Rheumatology, Hospital Virgen de las Nieves, Granada, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Bravo
authors.affiliation: Department of Rheumatology, Complexo Hospitalario A Coruña (CHUAC), Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Freire
authors.affiliation: Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Sheila
authors.initials: S
authors.lastname: Melchor
authors.affiliation: Department of Rheumatology, Hospital Universitario San Juan, Alicante, Spain.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Mínguez
authors.affiliation: Department of Autoimmune Diseases, Hospital San Cecilio, Granada, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Salvatierra
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: González-Vela
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
authors.forename: Vanesa
authors.initials: V
authors.lastname: Calvo-Río
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Santos-Gómez
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
authors.forename: Trinitario
authors.initials: T
authors.lastname: Pina
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain. miguelaggay@hotmail.com.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: González-Gay
mesh_terms: D000293:Adolescent; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013625:Takayasu Arteritis / Q000188:drug therapy*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C502936:tocilizumab