Tocilizumab in refractory Caucasian Takayasu’s arteritis: a multicenter study of 54 patients and literature review

Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu's arteritis (TAK) in clinical practice. Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-...

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Autores: Prieto Peña, Diana, Bernabeu, Pilar, Vela, Paloma, Narváez, Javier, Fernández López, Jesús C., Freire González, Mercedes, González Álvarez, Beatriz, Solans Laqué, Roser, Callejas Rubio, José Luis, Ortego Centeno, Norberto, Fernández Díaz, Carlos, Rubio, Esteban, García Morillo, Salvador, Minguez, Mauricio, Fernández Carballido, Cristina, Miguel, Eugenio de, Melchor, Sheila, Salgado Pérez, Eva, Bravo, Beatriz, Romero Yuste, Susana, Salvatierra, Juan, Hidalgo, Cristina, Manrique Arija, Sara, Romero Gómez, Carlos, Moya, Patricia, Álvarez Rivas, Noelia, Mendizabal, Javier, Ortiz Sanjuán, Francisco, Pérez de Pedro, Iván, Alonso Valdivielso, José L., Pérez Sánchez, Laura, Roldán, Rosa, Fernandez-Llanio, Nagore, Gómez de la Torre, Ricardo, Suarez, Silvia, Montesa Cabrera, María Jesús, Delgado Sánchez, Mónica, Loricera, Javier, Atienza Mateo, Belén, Castañeda, Santos, González Gay, Miguel A., Blanco, Ricardo
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/179984
Acceso en línea:https://hdl.handle.net/2445/179984
Access Level:acceso abierto
Palabra clave:Arteritis
Blancs
Whites
Descripción
Sumario:Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu's arteritis (TAK) in clinical practice. Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZMONO) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZCOMBO) was performed. Results: The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42.0 (32.5-50.5) years. TCZ was started after a median (IQR) of 12.0 (3.0-31.5) months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%), and 27/36 (75%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30.0 mg/day (12.5-50.0) to 5.0 (0.0-5.6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73.7%) patients after a median (IQR) of 9.0 (6.0-14.0) months. Twenty-three (42.6%) patients were on TCZMONO and 31 (57.4%) on TCZCOMBO: MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZCOMBO were younger [38.0 (27.0-46.0) versus 45.0 (38.0-57.0)] years; difference (diff) [95% confidence interval (CI) = -7.0 (-17.9, -0.56] with a trend to longer TAK duration [21.0 (6.0-38.0) versus 6.0 (1.0-23.0)] months; diff 95% CI = 15 (-8.9, 35.5), and higher c-reactive protein [2.4 (0.7-5.6) versus 1.3 (0.3-3.3)] mg/dl; diff 95% CI = 1.1 (-0.26, 2.99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0.862). Relevant adverse events were reported in six (11.1%) patients, but only three developed severe events that required TCZ withdrawal. Conclusion: TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin.

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