Rescue treatment with tocilizumab for Takayasu arteritis resistant to TNF-α blockers

Clin Exp Rheumatol. Jan-Feb 2012;30(1 Suppl 70):S90-3. Epub 2012 May 11.

Abstract

Anti-TNF-α therapy has successfully been used to treat Takayasu arteritis (TA) refractory to conventional immunosuppressive treatment. However, some patients fail to respond even to TNF-α blockers. Interleukin-6 (IL-6) is a key player in the pathogenesis of TA. Preliminary data also suggest efficacy of the IL-6 receptor inhibitor tocilizumab in patients with large-vessel vasculitis. We report a patient with TA refractory to multiple conventional immunosuppressive agents and two TNF-α blockers successfully treated with monthly tocilizumab infusions (8 mg/kg body weight) for 6 consecutive months. Clinical indices of disease activity, inflammatory markers, and 18Ffluorodeoxyglucose positron emission/computerised tomography findings normalised, while the prednisone dosage could be tapered. Serum IL-6 and soluble IL-6 receptor (sIL-6R) levels raised during tocilizumab treatment consistent with the mode of action of tocilizumab. Tocilizumab holds promise for patients with refractory TA. Larger studies are required to confirm our findings.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Compassionate Use Trials
  • Drug Administration Schedule
  • Drug Resistance*
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Inflammation Mediators / blood
  • Infusions, Intravenous
  • Interleukin-6 / blood
  • Multimodal Imaging
  • Positron-Emission Tomography
  • Predictive Value of Tests
  • Radiopharmaceuticals
  • Receptors, Interleukin-6 / antagonists & inhibitors*
  • Receptors, Interleukin-6 / blood
  • Salvage Therapy*
  • Takayasu Arteritis / blood
  • Takayasu Arteritis / diagnosis
  • Takayasu Arteritis / drug therapy*
  • Takayasu Arteritis / immunology
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Tumor Necrosis Factor-alpha / blood
  • Whole Body Imaging

Substances

  • Antibodies, Monoclonal, Humanized
  • IL6 protein, human
  • IL6R protein, human
  • Immunosuppressive Agents
  • Inflammation Mediators
  • Interleukin-6
  • Radiopharmaceuticals
  • Receptors, Interleukin-6
  • Tumor Necrosis Factor-alpha
  • Fluorodeoxyglucose F18
  • tocilizumab