Rapid control of disease activity by tocilizumab in 10 'difficult-to-treat' cases of Takayasu arteritis
Rapid control of disease activity by tocilizumab in 10 'difficult-to-treat' cases of Takayasu arteritis
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DOI：
10.1111/1756-185x.12220
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发表时间：
2013-12-01
影响因子：
2.5
通讯作者：
Joseph, George
中科院分区：
文献类型：
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作者：
Goel, Ruchika;Danda, Debashish;Joseph, George
目的：评估10例“难治性”大动脉炎（TA）患者接受托珠单抗治疗的结局。方法：研究10例接受至少6次托珠单抗输注的TA患者的记录，并分析与人口统计学、药物、调查、血管造影和结局相关的数据。10例患者的中位年龄、病程和Indian Takayasu动脉炎评分（ITAS）分别为24.5（1353）岁、25.5（1.5-60）个月和4.5（0-13）。所有患者均患有ITAS>= 1的活动性疾病和/或尽管接受了中位持续时间为27（15-60）个月的类固醇和二线药物治疗，但血管造影仍活跃。托珠单抗导致临床应答，ITAS为0，第4次输注时100%患者的急性期反应物（APR）减少。6例患者（60%）在第6次输注前保持临床反应，影像学疾病稳定，APR正常。基线时APR正常的3例患者中有2例（66%）达到并维持了稳定的疾病状态，直至末次输注，而基线时APR高的患者中有49.2%（4/7）的应答者。托珠单抗促进类固醇剂量从24 +/- 15 mg/天快速降低至5.4 +/- 4.9 mg/天（P = 0.003）。然而，在6次输注后停止托立珠单抗治疗后，只有2例患者保持稳定的疾病状态，其中大多数需要补救治疗。结论：托珠单抗可能是一种有效的类固醇节省选择快速控制难治性疾病活动的TA患者。但是，这种福利在取消后就不能维持。
Aim: To assess outcome of 10 'difficult to treat' patients with Takayasu arteritis (TA) treated with tocilizumab.Methods: Records of 10 patients with TA who received at least six infusions of tocilizumab were studied and data related to demography, medications, investigations, angiography and outcome were analyzed.Results: Median age, disease duration and Indian Takayasu Arteritis Score (ITAS) of 10 patients were 24.5 (1353) years, 25.5 (1.5-60) months and 4.5 (0-13), respectively. All patients had active disease with ITAS of >= 1 and/or they were angiographically active in spite of treatment with steroids and second line agents for a median duration of 27 (15-60) months. Tocilizumab led to a clinical response with ITAS of 0 and reduction in acute phase reactants (APR) in 100% of patients by the fourth infusion. Six patients (60%) maintained clinical response with radiologically stable disease and normal APR up to the sixth infusion. Two out of three patients (66%) with normal APR at baseline achieved and maintained stable disease state up to the last infusion, in contrast to 49.2% (4/7) responders in those with baseline high APR. Tocilizumab facilitated rapid reduction in steroid dose from 24 +/- 15 to 5.4 +/- 4.9 mg/day (P = 0.003). However, following discontinuation of toclizumab therapy after six infusions, only two patients maintained stable disease state and the majority of them needed rescue therapy. There was no major adverse event or fatality.Conclusion: Tocilizumab may be an effective steroid-sparing option for rapid control of refractory disease activity in patients of TA. However, the benefit is not sustained after its withdrawal.