International Heart Journal
Online ISSN : 1349-3299
Print ISSN : 1349-2365
ISSN-L : 1349-2365
Clinical Studies
Tocilizumab for the Treatment of Patients With Refractory Takayasu Arteritis
Yoshikazu Nakaoka, Kaori Higuchi, Yoh Arita, Michio Otsuki, Kaori Yamamoto, Takahiro Hashimoto-Kataoka, Taku Yasui, Kuniyasu Ikeoka, Tomohito Ohtani, Yasushi Sakata, Yoshihito Shima, Atsushi Kumanogoh, Keiko Yamauchi-Takihara, Toshio Tanaka, Tadamitsu Kishimoto, Issei Komuro
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Keywords: Interleukin-6 (IL-6), Cytokine, Inflammation, Monoclonal antibody, Relapsing
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2013 Volume 54 Issue 6 Pages 405-411

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Abstract

Treatment of refractory Takayasu arteritis (TA) remains an unresolved clinical issue. Patients usually respond to glucocorticoid (GC) therapy, but often relapse on tapering of the GC dose. The aim of the present study was to assess the safety and efficacy of the interleukin-6 (IL-6) receptor antibody tocilizumab (TCZ) in patients with TA refractory to conventional therapies including GC. Four patients with TA who had shown GC resistance received TCZ infusions (8 mg/kg) every 4 weeks a total of at least 24 times (range, 24 to 51). Clinical symptoms, the serum levels of acute phase proteins and IL-6, GC dosage necessary to maintain remission, and cross-sectional imaging by enhanced CT and MRI were assessed. All patients achieved good clinical response and rapid normalization of the acute phase proteins such as C-reactive protein and serum amyloid A during the therapy with TCZ. The mean dosage of prednisolone could be reduced from 21.3 mg/day to 1.5 mg/day. Although the serum IL-6 level was transiently elevated in all patients after several TCZ infusions, it gradually recovered to the initial level. Along with the decrease of serum IL-6, two patients exhibited signifi cant reduction in thickened arterial lesions. No drug-related adverse effects were noted. In this small group of patients with refractory TA, TCZ therapy was effective and well-tolerated. Further larger studies should be conducted to confirm this finding.

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© 2013 by the International Heart Journal Association
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