Rapid induction of remission in large vessel vasculitis by IL-6 blockade. A case series

To evaluate the effect of IL-6 blockade using tocilizumab in inducing remission of arterial large vessel vasculitides (LVV). Five consecutive patients with giant-cell arteritis (GCA) and two with Takayasu's arteritis (TA) were treated by tocilizumab infusions (8 mg/kg). Tocilizumab was given ev...

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Bibliographic Details
Published in:Swiss medical weekly 2011, Vol.141, p.w13156-w13156
Main Authors: Seitz, Michael, Reichenbach, Stephan, Bonel, Harald M, Adler, Sabine, Wermelinger, Felix, Villiger, Peter M
Format: Article
Language:English
Subjects:
Adult
Aged
Antibodies, Monoclonal - administration & dosage
Antibodies, Monoclonal - pharmacology
Antibodies, Monoclonal - therapeutic use
Antibodies, Monoclonal, Humanized
Female
Giant Cell Arteritis - drug therapy
Giant Cell Arteritis - physiopathology
Giant Cell Arteritis - prevention & control
Humans
Interleukin-6 - antagonists & inhibitors
Interleukin-6 - secretion
Male
Middle Aged
Outcome Assessment (Health Care)
Prospective Studies
Remission Induction - methods
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Summary:To evaluate the effect of IL-6 blockade using tocilizumab in inducing remission of arterial large vessel vasculitides (LVV). Five consecutive patients with giant-cell arteritis (GCA) and two with Takayasu's arteritis (TA) were treated by tocilizumab infusions (8 mg/kg). Tocilizumab was given every other week for the first month and once monthly thereafter. Clinical symptoms of disease activity, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level and glucocorticoid (GC) dosage necessary to maintain remission were prospectively assessed. MR angiography was performed to monitor local inflammation. Of the seven patients three were newly diagnosed and four showed GC resistance, i.e. GC could not be lowered to less than 7.5 mg/day. The mean follow-up time was 4.3 months (range 3-7 months). All patients achieved a rapid and complete clinical response and normalisation of the acute phase proteins. Remarkably, prednisone dosage could be reduced within 12 weeks to a mean of 2.5 mg/day (range 0-10 mg/day). No relapse and no drug-related side effects were noted. Collectively the data suggest that IL-6 blockade using tocilizumab qualifies as a therapeutic option to induce rapid remission in large vessel vasculitides.
ISSN:1424-3997
DOI:10.4414/smw.2011.13156