Rapid control of disease activity by tocilizumab in 10 ‘difficult-to-treat’ cases of Takayasu arteritis

Abstract

To assess outcome of 10 'difficult to treat' patients with Takayasu arteritis (TA) treated with tocilizumab. 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. Median age, disease duration and Indian Takayasu Arteritis Score (ITAS) of 10 patients were 24.5 (13-53) 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. 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.