TY - JOUR
T1 - Tocilizumab in refractory Caucasian Takayasu's arteritis :
T2 - a multicenter study of 54 patients and literature review
AU - Prieto-Peña, Diana
AU - Bernabeu, Pilar
AU - Vela, Paloma
AU - Narváez, Javier
AU - Fernández-López, Jesús C
AU - Freire-González, Mercedes
AU - González-Álvarez, Beatriz
AU - Solans, Roser
AU - Callejas Rubio, Jose Luis
AU - Ortego, Norberto
AU - Fernández-Díaz, Carlos
AU - Rubio, Esteban
AU - García-Morillo, Salvador
AU - Minguez, Mauricio
AU - Fernández-Carballido, Cristina
AU - de Miguel, Eugenio
AU - Melchor, Sheila
AU - Salgado, Eva
AU - Bravo, Beatriz
AU - Romero-Yuste, Susana
AU - Salvatierra, Juan
AU - Hidalgo, Cristina
AU - Manrique, Sara
AU - Romero-Gómez, Carlos
AU - Moya, Patricia
AU - Álvarez-Rivas, Noelia
AU - Mendizabal, Javier
AU - Ortiz-Sanjuán, Francisco
AU - Pérez de Pedro, Iván
AU - Alonso-Valdivielso, José L.
AU - Perez-Sanchez, Laura
AU - Roldán, Rosa
AU - Fernandez-Llanio, Nagore
AU - Gómez de la Torre, Ricardo
AU - Suarez, Silvia
AU - Montesa Cabrera, María Jesús
AU - Delgado Sánchez, Mónica
AU - Loricera, Javier
AU - Atienza-Mateo, Belén
AU - Castañeda, Santos
AU - Gonzalez-Gay, MA
AU - Blanco, Ricardo
PY - 2021
Y1 - 2021
N2 - 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 (TCZ) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZ) 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 TCZ and 31 (57.4%) on TCZ: MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZ 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.
AB - 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 (TCZ) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZ) 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 TCZ and 31 (57.4%) on TCZ: MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZ 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.
KW - Biological therapy
KW - Caucasian
KW - Cdmards
KW - Takayasu's arteritis
KW - Tocilizumab
U2 - 10.1177/1759720X211020917
DO - 10.1177/1759720X211020917
M3 - Article
C2 - 34211589
SN - 1759-7218
VL - 13
JO - Therapeutic Advances in Musculoskeletal Disease
JF - Therapeutic Advances in Musculoskeletal Disease
ER -