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Tocilizumab in refractory aortitis: study on 16 patients and literature review

Abstract: OBJECTIVES: Non-infectious aortitis is often refractory to standard immunosuppressive therapy. Since IL-6 has been implicated in the pathogenesis of aortitis, we assessed the efficacy of the anti-IL6 receptor monoconal antibody tocilizumab (TCZ) in a series of patients with refractory non-infectious aortitis. METHODS: Review of 16 patients (14 women/2 men) with refractory aortitis diagnosed by imaging (CT angiography, MR angiography, and/or PET) that were treated with TCZ. RESULTS: The mean age±SD was 51.4±20.1 years. The underlying conditions were: Takayasu arteritis (TakA) (n=7 cases), giant cell arteritis (GCA) (n=7), relapsing polychondritis (RP) (n=1), and aortitis associated with retroperitoneal fibrosis (n=1). TCZ was the first biologic drug used in all patients with GCA and in the patient with aortitis associated with retroperitoneal fibrosis but in only 2 of 7 TakA patients. In the remaining cases anti-TNF inhibitors were prescribed before TCZ (standard dose was 8 mg/kg/iv/4 weeks). After a mean±SD follow-up of 11.8±6.6 months most patients experienced clinical improvement, showing reduction of erythrocyte sedimentation rate from 43±36 mm/1st h to 5±4 mm/1st h at last visit. At TCZ onset, 25% of patients had fever and 19% polymyalgia rheumatica. These manifestations disappeared after 3 months of TCZ therapy. A corticosteroid sparing effect was also achieved (from 27.3±17.6 mg/day of prednisone at TCZ onset to 4.2±3.8 mg/day at last visit). TCZ had to be discontinued in a patient because of severe neutropenia. CONCLUSIONS: TCZ appears to be effective and relatively safe in patients with inflammatory aortitis refractory to corticosteroids or to other biologic immunosuppressive drugs.

Otras publicaciones de la misma revista o congreso con autores/as de la Universidad de Cantabria

 Fuente: Clin Exp Rheumatol. 2014 May-Jun;32(3 Suppl 82):S79-89

Editorial: Clinical and Experimental Rheumatology

 Año de publicación: 2014

Nº de páginas: 11

Tipo de publicación: Artículo de Revista

ISSN: 0392-856X,1593-098X

Proyecto español: RD08/0075 ; RD12/0009/0013

Autores/as

LORICERA, JAVIER

RICARDO BLANCO ALONSO

CASTAÑEDA, SANTOS

HUMBRÍA, ALICIA

ORTEGO CENTENO, NORBERTO

NARVÁEZ, JAVIER

MATA, CRISTINA

MELCHOR, SHEILA

AURRECOECHEA, ELENA

CALVO ALÉN, JAIME

LLUCH, PAU

MOLL, CONCEPCIÓN

PEIRÓ, ENRIQUETA

JAVIER RUEDA GOTOR

PINA MURCIA, TRINITARIO

PALMOU FONTANA, NATALIA

CALVO RÍO, VANESA

ORTIZ SANJUÁN, FRANCISCO