Tocilizumab in refractory Caucasian Takayasu's arteritis : a multicenter study of 54 patients and literature review
Prieto-Peña, Diana (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Bernabeu, Pilar (Hospital General Universitario de Alicante (Alacant, País Valencià))
Vela, Paloma (Hospital General Universitario de Alicante (Alacant, País Valencià))
Narváez, Javier (Hospital Universitari de Bellvitge)
Fernández-López, Jesus C. (Complejo H. Universitario de A Coruña)
Freire-González, Mercedes (Complejo H. Universitario de A Coruña)
González-Álvarez, Beatriz (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Solans, Roser (Hospital Universitari Vall d'Hebron)
Callejas Rubio, Jose Luis (Hospital Universitario San Cecilio (Granada))
Ortego, Norberto (Hospital Universitario San Cecilio (Granada))
Fernández-Díaz, Carlos (IIS-Princesa)
Rubio, Esteban (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
García-Morillo, Salvador (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Minguez, Mauricio (Hospital San Juan de Alicante)
Fernández-Carballido, Cristina (Hospital San Juan de Alicante)
de Miguel, Eugenio (Hospital Universitario La Paz (Madrid))
Melchor, Sheila (Hospital Universitario)
Salgado, Eva (Complejo H. Universitario de Ourense)
Bravo, Beatriz (Hospital Universitario Virgen de las Nieves (Granada))
Romero-Yuste, Susana (Complejo H. Universitario de Pontevedra)
Salvatierra, Juan (Hospital Universitario San Cecilio (Granada))
Hidalgo, Cristina (Complejo Universitario de Salamanca)
Manrique, Sara (Hospital Regional Universitario de Málaga)
Romero-Gómez, Carlos (Hospital Regional Universitario de Málaga)
Moya, Patricia (Institut d'Investigació Biomèdica Sant Pau)
Álvarez-Rivas, Noelia (Hospital Universitario San Agustín (Avilés))
Mendizabal, Javier (Complejo Hospitalario de Navarra)
Ortiz-Sanjuán, Francisco (Hospital Universitari i Politècnic La Fe (València))
Pérez de Pedro, Iván (Hospital Regional Universitario Carlos Haya (Málaga))
Alonso-Valdivielso, José L. (Hospital Universitario de Burgos)
Perez-Sanchez, Laura (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Roldán, Rosa (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Fernandez-Llanio, Nagore (Hospital Arnau de Vilanova (València))
Gómez de la Torre, Ricardo (Hospital Universitario Central de Asturias)
Suarez, Silvia (Hospital Universitario Central de Asturias)
Montesa Cabrera, María Jesús (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Delgado Sánchez, Mónica (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Loricera, Javier (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Atienza-Mateo, Belén (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Castañeda, Santos (IIS-Princesa)
Gonzalez-Gay, MA (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Blanco, Ricardo (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))

Date:	2021
Abstract:	Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu's arteritis (TAK) in clinical practice. Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZ) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZ) was performed. Results: The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42. 0 (32. 5-50. 5) years. TCZ was started after a median (IQR) of 12. 0 (3. 0-31. 5) months since TAK diagnosis. Remission was achieved in 12/54 (22. 2%), 19/49 (38. 8%), 23/44 (52. 3%), and 27/36 (75%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30. 0 mg/day (12. 5-50. 0) to 5. 0 (0. 0-5. 6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73. 7%) patients after a median (IQR) of 9. 0 (6. 0-14. 0) months. Twenty-three (42. 6%) patients were on TCZ and 31 (57. 4%) on TCZ: MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZ were younger [38. 0 (27. 0-46. 0) versus 45. 0 (38. 0-57. 0)] years; difference (diff) [95% confidence interval (CI) = -7. 0 (-17. 9, -0. 56] with a trend to longer TAK duration [21. 0 (6. 0-38. 0) versus 6. 0 (1. 0-23. 0)] months; diff 95% CI = 15 (-8. 9, 35. 5), and higher c-reactive protein [2. 4 (0. 7-5. 6) versus 1. 3 (0. 3-3. 3)] mg/dl; diff 95% CI = 1. 1 (-0. 26, 2. 99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0. 862). Relevant adverse events were reported in six (11. 1%) patients, but only three developed severe events that required TCZ withdrawal. Conclusion: TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin.
Grants:	Instituto de Salud Carlos III RD08/0075 Instituto de Salud Carlos III RD12/0009/0013 Instituto de Salud Carlos III RD16/0012
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Biological therapy ; Caucasian ; Cdmards ; Takayasu's arteritis ; Tocilizumab
Published in:	Therapeutic Advances in Musculoskeletal Disease, Vol. 13 (2021) , ISSN 1759-7218

DOI: 10.1177/1759720X211020917
PMID: 34211589

12 p, 637.7 KB

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