Rapid induction of remission in large vessel vasculitis by IL-6 blockade. A case series

Swiss Med Wkly. 2011 Jan 17;141:w13156. doi: 10.4414/smw.2011.13156. eCollection 2011.

Abstract

Objective: To evaluate the effect of IL-6 blockade using tocilizumab in inducing remission of arterial large vessel vasculitides (LVV).

Methods: Five consecutive patients with giant-cell arteritis (GCA) and two with Takayasu's arteritis (TA) were treated by tocilizumab infusions (8 mg/kg). Tocilizumab was given every other week for the first month and once monthly thereafter. Clinical symptoms of disease activity, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level and glucocorticoid (GC) dosage necessary to maintain remission were prospectively assessed. MR angiography was performed to monitor local inflammation.

Results: Of the seven patients three were newly diagnosed and four showed GC resistance, i.e. GC could not be lowered to less than 7.5 mg/day. The mean follow-up time was 4.3 months (range 3-7 months). All patients achieved a rapid and complete clinical response and normalisation of the acute phase proteins. Remarkably, prednisone dosage could be reduced within 12 weeks to a mean of 2.5 mg/day (range 0-10 mg/day). No relapse and no drug-related side effects were noted.

Conclusion: Collectively the data suggest that IL-6 blockade using tocilizumab qualifies as a therapeutic option to induce rapid remission in large vessel vasculitides.

MeSH terms

  • Adult
  • Aged
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / pharmacology
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Humanized
  • Female
  • Giant Cell Arteritis / drug therapy*
  • Giant Cell Arteritis / physiopathology
  • Giant Cell Arteritis / prevention & control*
  • Humans
  • Interleukin-6 / antagonists & inhibitors*
  • Interleukin-6 / metabolism
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Prospective Studies
  • Remission Induction / methods*

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Interleukin-6
  • tocilizumab