The efficacy of tocilizumab on the treatment of Chinese Takayasu's arteritis

Abstract

Objective The aim of this study was to evaluate the long-term efficacy and safety of tocilizumab (TCZ) in Chinese patients with Takayasu's arteritis (TA). Methods We retrospectively studied the active TA patients treated with TCZ from January 2014 to April 2016 in our hospital. The demographic and clinical data, laboratory tests and vascular images were collected. Doppler ultrasonography was used to track vascular changes during TCZ treatment. The data were analyzed by t test and rank sum test. The data were analyzed by Fisher exact test or Chi square test. Results Eighteen patients with a median age of 25.5 (range 18, 47) were analyzed. Seventeen patients had taken a median of 3 (range 1, 5) immune suppressants before TCZ therapy. Three patients withdrew TCZ after receiving 1 infusion each due to unbearable neck pain. The other 15 patients were treated with TCZ for a median of 13 (range 6, 26) months. After TCZ treatment, the median ESR level, hsCRP level, mural thickness of common carotid artery and subclavical artery decreased from 45.5 (range 7-101) mm/1 h (Z=6.731, P<0.01), 37.40 (range 7.6-163.12) mg/L, 0.25 (range 0.06-0.59) cm, 0.18 (range 0.07-0.47) cm to 7 (range 1-44) mm/1 h (Z=6.731, P<0.01), 0.94 (range 0.08-93.21) mg/L (Z=3.212, P=0.016), 0.18 (range 0.04-0.53) cm (Z=4.873, P=0.001), and 0.12 (range 0.07-0.18) cm (Z=5.568, P<0.01) respectively, with median glucocorticoid dosage being successfully tapered. One patient discontinued TCZ for unsatisfactory response after 6 TCZ infusions. One episode of urinary infection was recorded and relieved after antibiotic therapy. Neither neutropenia nor abnormal liver enzyme was observed. Conclusion Our study suggests that tocilizumab is a safe and effective agent for long term use among Chinese TA patients, especially for those refractory cases. Key words: Takayasus arteritis; Tocilizumab; Efficacy; Safety