Tocilizumab for Treating Takayasu's Arteritis and Associated Stroke: A Case Series and Updated Review of the Literature

Abstract

Takayasu's arteritis (TA) is a rare inflammatory disease that can result in stroke. Treatment of patients with TA requires prolonged use of corticosteroids (CS). We assessed the effectiveness of tocilizumab (TCZ) in inducing disease remission and reducing CS doses in patients with TA. We retrospectively reviewed all patients with TA treated with TCZ and determined their response to therapy and adverse effects. We also summarized all reported TA patients treated with TCZ in the literature (both PubMed and MEDLINE) with no date or language restrictions and determined the utility of TCZ in inducing remission, acting as a CS sparing agent, and its adverse effects. TCZ induced remission and reduction of CS doses in all 3 cases of TA in our cohort. Remission was achieved in 2 patients where stroke was the initial manifestation of active TA. In total, 3 of 4 patients with TA and stroke (2 from our study and 2 from other studies) treated with TCZ achieved remission and stability of their disease. We also identified 30 patients with TA treated with TCZ in the literature, of which 76.7% achieved remission despite the lack of sustained remission with other biological agents. In addition, TCZ resulted in a statistically significant reduction of CS in patients on CS before using TCZ (median, -8.8mg/day; interquartile range, -19.4, to -3.4mg/day; Wilcoxon P value, .0002). TCZ is a promising alternative for treating TA refractory to other biologics and for TA patients with stroke.