Subcutaneous administration of tocilizumab is effective in myointimal hyperplasia remodelling in refractory Takayasu arteritis
Subcutaneous administration of tocilizumab is effective in myointimal hyperplasia remodelling in refractory Takayasu arteritis
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DOI：
10.4081/reumatismo.2017.1013
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发表时间：
2017-01-01
期刊：
影响因子：
1.4
通讯作者：
Imbalzano, E.
中科院分区：
文献类型：
--
作者：
Lo Gullo, A.;Mandraffino, G.;Imbalzano, E.
多发性大动脉炎（TA）是一种病因不明的慢性炎症性疾病，累及大中型动脉，主要是主动脉及其主要分支。TA是一种治疗挑战，因为皮质类固醇和常规免疫抑制剂并不总是有效或安全的。白细胞介素6（IL-6）已成为TA发病机制中的关键细胞因子，其血清水平已被证明与疾病活动性密切相关。我们报告了一名19岁的女性TA患者，常规免疫抑制剂无效，成功地用皮下注射抗IL-6受体的人源化单克隆抗体托珠单抗治疗，其中超声检查被用作成像工具来跟踪患者。目前，疾病活动的临床指标，炎症标志物，颈动脉内膜中层厚度（cIMT）以及颈动脉脉搏波速度（cPWV）正常化，而泼尼松剂量已逐渐减少。托珠单抗似乎是一个很好的选择难治性TA，具有显着的类固醇节省效果。此外，它似乎对内皮功能有有利的影响，因为它改善了cIMT和PWV。
Takayasu arteritis (TA) is a chronic inflammatory disease of unknown origin that involves large and medium-sized arteries, primarily the aorta and its major branches. TA is a therapeutic challenge because corticosteroids and conventional immunosuppressive agents are not always effective or safe. Interleukin 6 (IL-6) has emerged as a key cytokine in the pathogenesis of TA and its serum levels have been shown to well correlate with disease activity.We report a 19 years old female patient with TA refractory to conventional immunosuppressive agents, success-fully treated with subcutaneous tocilizumab, a humanized monoclonal antibody against IL-6 receptor, in which ultrasonography US) was used as imaging tool to follow up the patient. Currently, clinical indices of disease activity, inflammatory markers, carotid intima media thickness (cIMT) as well as carotid pulse wave velocity (cPWV) normalised, while the prednisone dosage has been tapered.Tocilizumab appears to be a good option in refractory TA, with a remarkable steroid-sparing effect. In addition, it seems to have a favourable effect on endothelial function, as it improved cIMT and PWV.