Evaluation of tocilizumab for intractable Takayasu arteritis and 18F-fluorodeoxyglucose-positron emission tomography for detecting inflammation under tocilizumab treatment

Abstract

Background: Although high-dose glucocorticoids are effective in suppressing active inflammation of Takayasu arteritis (TAK), many patients experience relapse during tapering of glucocorticoids. Recently, the interleukin-6 receptor antibody, tocilizumab (TCZ), was reported to be effective for steroid-resistant TAK. However, there are no objective ways of diagnosing TAK recurrence because TCZ suppresses inflammatory biomarkers.Objectives: To investigate the efficacy of TCZ at 1-year follow-up and of 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography for detection of recurrence of inflammation during TCZ treatment. Methods and Results:We treated 19 patients with refractory TAK with TCZ. TCZ was discontinued in 2 cases because of side effects. Abatement of arteritis symptoms along with reduction of glucocorticoid dosage was achieved in 12 patients, resulting in a remission induction rate of 70.6%. The dosage of glucocorticoid was reduced from 16.1 ± 10.2 mg to 3.8 ± 1.7 mg at 1 year ( p < 0.001) in these patients. In the remaining 5 patients, glucocorticoid tapering led to exacerbation of symptoms and glucocorticoid dose had to be increased. FDG-PET scan results closely matched clinical course in all 5 patients with recurrence even during TCZ treatment, while the scan was negative for the remaining 12 patients.Conclusions: TCZ injection provides robust steroid-sparing effect and improvement of inflammation without significant adverse effects. Recurrence of inflammation can be detected by FDG-PET even during TCZ treatment.

Efficacy of tocilizumab for refractory Takayasu arteritis: a retrospective study and literature review

“…However, in China, 18F-FDG-PET was not extensively recommended to TAK patients because of high fees of 18F-FDG-PET. Recent studies recommended the 18F-FDG-PET for monitoring the disease activity of TAK including assessment of the recurrence of TAK, since 18F-FDG-PET showed the simultaneous changes of inflammation in arterial walls and clinical course under the therapy of TCZ [38,39]. In summary, FDG-PET is a promising checking method to aid the clinical evaluation of disease activity.…”

Coronary ostial angioplasty for juvenile Takayasu arteritis involving the coronary artery using external iliac artery grafts

“…EIA was histologically muscular throughout its length (Fig. 2 B, C). The aorta was transected 15 mm above the left and right coronary artery origins.…”

“…Takayasu arteritis (TAK) is often associated with coronary artery ostial lesions [ 1 ] and treated using corticosteroids and immunosuppressive agents. However, refractory cases are treated with infliximab or tocilizumab (TCZ) [ 2 ]. Treating severe coronary artery stenosis is challenging with medication alone and often requires surgery [ 3 ], such as coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and ostial coronary artery angioplasty.…”

Systematic review and meta-analysis of the current literature on tocilizumab in patients with refractory Takayasu arteritis

“…Of these, 108 studies were excluded due to a sample size of less than five patients, conference abstracts, letters, non-refractory TAK, duplicate patients, or unavailable data. Ultimately, 19 studies fulfilled our inclusion criteria and were included in this meta-analysis (13, [18][19][20][21][22][23][24][25][26][27][28][29][36][37][38][39][40][41]. A flow diagram of the literature search and selection is shown in Figure 1.…”

“…Recently, a series of studies concerning efficacy and safety of TCZ in refractory TAK patients have been published (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). This systematic review and meta-analysis presents pooled quantitative evidence of baseline characteristics and clinical outcomes of TCZ in refractory TAK patients.…”