Anti-interleukin-6 tocilizumab therapy in Takayasu's arteritis: a real life experience

Abstract

Background/aim: Tumour necrosis factor inhibitors and anti-interleukin-6 anti-IL-6 therapies are increasingly being used in Takayasu's arteritis TA patients who are unresponsive to corticosteroids ± conventional immunosuppressive agents.The aim of this study is to assess the efficacy and safety of anti-IL-6 tocilizumab therapy in refractory TA patients in real life.Materials and methods: Fifteen TA patients 86.7% were female who received at least 3 cycles of tocilizumab therapy were retrospectively assessed by clinical, laboratory, and radiological evaluations before and after tocilizumab therapy. Results: The median min-max age of the patients at evaluation was 35 20-58 years and the median disease duration from diagnosis was 24 12-168 months. The median min.-max. duration of follow-up after tocilizumab was 15 3-42 months. There was a significant decrease in erythrocyte sedimentation rate ESR , C-reactive protein CRP , and patient global visual analogue scale VAS scores of patients after tocilizumab therapy. The median min.-max. ESR was 26 5-119 vs. 3 2-49 mm/h, P = 0.02; CRP was 39.8 2.4-149.0 vs. 7.9 0-92.9 mg/L, P = 0.017; and patient global VAS was 50 0-90 vs. 30 0-60 , P = 0.027, respectively. In 8 patients, ESR and CRP levels were in the normal range in the last control. Imaging modality results after tocilizumab were available for 9 patients; 8 patients were radiologically stable and regression was seen in 1 patient. Comparable imaging modality results before and after tocilizumab were available for 5 patients; 4 patients were radiologically stable and regression was seen in 1 patient. Radiological findings were consistent with laboratory responses. Glucocorticoid dosages decreased from a mean dosage of 16.2 9.1 mg/day at baseline to 7.1 3.8 mg/day P = 0.001 at the last follow-up visit. There was no increase in the steroid dosage in any of the patients. All patients tolerated tocilizumab well. Conclusion: Based on retrospective real life data, anti-IL-6 tocilizumab appears to be an effective and tolerable treatment option in refractory TA patients.