New Treatment Strategies in Large-vessel Vasculitis

Sebastian Unizony; John H. Stone; James R. Stone


Curr Opin Rheumatol. 2013;25(1):3-9. 

In This Article

Anti-interleukin-6 Therapy (Tocilizumab) for Takayasu Arteritis

As in GCA, IL-6 is highly expressed within inflamed arteries in TAK,[48] and serum IL-6 levels correlate with disease activity.[49] During the early stages of the disease, IL-6 might be important in stimulating T cells and recruiting monocytes to the sites of inflammation. Later, IL-6 could be involved in angiogenesis and fibrosis.

Nishimoto et al.[50] reported successful use of tocilizumab in a patient with refractory TAK in 2008. Since then, eight additional cases of TAK treated with tocilizumab have been reported.[21,22,26,51,52] For these nine cases ( Table 2 ), IL-6R therapy was utilized for a mean period of 11 months (range 4–41 months). One case was treatment naive and received tocilizumab monotherapy, and eight patients were refractory to concomitant prednisone (mean dose 23 mg/day; range 5–40 mg/day) and other immunosuppressants (methotrexate, n = 5; azathioprine, n = 3; mycophenolate mofetil, n = 3; cyclophosphamiden = 2; cyclosporinen = 1; infliximab, n = 4; and adalimumabn = 1). All patients achieved disease control, and those on glucocorticoids were able to either discontinue or significantly taper prednisone after 3–6 months of tocilizumab therapy. Serial imaging in eight patients (MRA, n = 2; CT, n = 2; PET/CT, n = 4)showed improvement of vasculitic features in seven patients, evidenced by decreased vascular 18-fluordeoxyglucose uptake (n = 4), decreased vascular paramagnetic contrast enhancement (n = 2) or decreased aortic wall thickness (n = 1). One patient was shown to have a decrease in the thickness of the aortic wall following tocilizumab treatment, but progressive narrowing of the lumens of the renal, subclavian, and vertebral arteries was also observed.[51] One patient relapsed after 8 months of treatment while still receiving tocilizumabat 8 mg/kg every 4 weeks. A second patient relapsed within 3 months of discontinuing treatment.