Tocilizumab in refractory Takayasu arteritis: A case series and updated literature review

Background/purpose: The aim of this study is to analyze the efficacy and tolerance of tocilizumab in patients with Takayasu arteritis (TA). Methods: We retrospectively studied patients with TA (ACR and/or Ishikawa's criteria): 5 French multicenter cases and 39 from the literature. Clinical, biological, radiological disease activity and treatment were analyzed before tocilizumab, during the follow-up and at the last available visit. Results: Forty-four patients (median age 26 years [3-65];) were included in the present study: 5 patients from the 3 French university hospitals and 39 cases from the literature review. Median follow-up after initiation of tocilizumab was 15 months [8-33]. Clinical and biological activities significantly decreased within 3 months, similarly to steroid amount (from 15 mg/day [5-75] at baseline to 10 mg/day [2-30] at 6 months; p < 0.05) and steroid-dependence rate. Even radiological activity did not significantly decrease at 6 months, significant decrease of arterial FDG uptake was noted at 6 months. Median duration of tocilizumab treatment was 9 months [3-180]. At the last visit, tocilizumab was continued in 17/32 patients (53%), and was discontinued in the 15 remaining cases because of the remission (n = 5), relapse (n = 3), persistent radiological activity (n = 3), cutaneous rash (n = 2), severe infection (n = 1) and lacking of care welfare system (n = 1). No death related to tocilizumab treatment was noted. Conclusion: This study show the efficacy of tocilizumab in terms of clinical, biological and radiological response, as well as steroid-sparing agent. Only well-designed studies could definitely address the efficacy of tocilizumab in TA. (C) 2013 Elsevier B.V. All rights reserved.