What is the role of tocilizumab in the treatment of Takayasu arteritis?

Updated: Nov 14, 2018
  • Author: Jefferson R Roberts, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Evidence supports interleukin-6 (IL-6) as a major component in the inflammatory process of large-vessel vasculitis, and case reports and observational studies have shown that the humanized monoclonal antibody tocilizumab, which blocks the soluble IL-6 receptor, can produce clinical responses and have a steroid-sparing effect in patients with refractory Takayasu arteritis, including patients refractory to tumor necrosis factor (TNF) inhibitors. [42]

A retrospective study by the French Takayasu Network that included 46 patients concluded that tocilizumab is efficient and may reduce the incidence of relapses. Overall disease activity decreased, the daily prednisone dose decreased from 15 mg at baseline to 5 mg at 6 months, and the overall tocilizumab failure-free survival rate was 81% at 12 months and 48% at 48 months. [43]

A systematic review of tocilizumab therapy for Takayasu arteritis that included 105 patients, 76 of them with refractory disease, found that 85.7% of patients had an initial clinical response to within 3 months and 65.2% had radiological improvement; 90.4% were able to reduce their corticosteroid dose. Only 9% of patients experienced relapse while on therapy, but relapse after discontinuation of tocilizumab occurred in  46% of patients, at a median of 5 months. [44]

The TAKT trial—a randomized, double-blind, placebo-controlled, phase 3 study of the steroid-sparing effect of tocilizumab—failed to meet the primary endpoint. However, the results suggest a favorable effect of tocilizumab over placebo for time to relapse of Takayasu arteritis and found no new safety concerns. [42]   


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