Tocilizumab in refractory Caucasian Takayasu's arteritis: a multicenter study of 54 patients and literature review
Por:
Prieto-Pena, D, Bernabeu, P, Vela, P, Narvaez, J, Fernandez-Lopez, J, Freire-Gonzalez, M, Gonzalez-Alvarez, B, Solans-Laque, R, Rubio, J, Ortego, N, Fernandez-Diaz, C, Rubio, E, Garcia-Morillo, S, Minguez, M, Fernandez C, de Miguel, E, Melchor, S, Salgado, E, Bravo, B, Romero-Yuste, S, Salvatierra, J, Hidalgo, C, Manrique, S, Romero-Gomez, C, Moya, P, Alvarez-Rivas, N, Mendizabal, J, Ortiz-Sanjuan, F, de Pedro, I, Alonso-Valdivielso, J, Perez-Sanchez, L, Roldan, R, Fernandez-Llanio, N, de la Torre, R, Suarez, S, Cabrera, M, Sanchez, M, Loricera, J, Atienza-Mateo, B, Castaneda, S, Gonzalez-Gay, M and Blanco, R
Publicada:
1 jun 2021
Categoría:
Orthopedics and sports medicine
Resumen:
Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu's arteritis (TAK) in clinical practice.
Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZ(MONO)) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZ(COMBO)) was performed.
Results: The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42.0 (32.5-50.5) years. TCZ was started after a median (IQR) of 12.0 (3.0-31.5) months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%), and 27/36 (75%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30.0 mg/day (12.5-50.0) to 5.0 (0.0-5.6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73.7%) patients after a median (IQR) of 9.0 (6.0-14.0) months. Twenty-three (42.6%) patients were on TCZ(MONO) and 31 (57.4%) on TCZ(COMBO): MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZ(COMBO) were younger [38.0 (27.0-46.0) versus 45.0 (38.0-57.0)] years; difference (diff) [95% confidence interval (CI) = -7.0 (-17.9, -0.56] with a trend to longer TAK duration [21.0 (6.0-38.0) versus 6.0 (1.0-23.0)] months; diff 95% CI = 15 (-8.9, 35.5), and higher c-reactive protein [2.4 (0.7-5.6) versus 1.3 (0.3-3.3)] mg/dl; diff 95% CI = 1.1 (-0.26, 2.99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0.862). Relevant adverse events were reported in six (11.1%) patients, but only three developed severe events that required TCZ withdrawal.
Conclusion: TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin.
Filiaciones:
Prieto-Pena, D:
Hosp Univ Marques de Valdecilla, Dept Rheumatol, IDIVAL, Res Grp Genet Epidemiol & Atherosclerosis Syst Di, Santander, Spain
Bernabeu, P:
Hosp Gen Alicante, Dept Rheumatol, Alicante, Spain
Vela, P:
Hosp Gen Alicante, Dept Rheumatol, Alicante, Spain
Narvaez, J:
Hosp Bellvitge Princeps Espanya, Dept Rheumatol, Barcelona, Spain
Fernandez-Lopez, J:
Complejo Hosp Univ A Coruna, Dept Rheumatol, La Coruna, Spain
Freire-Gonzalez, M:
Complejo Hosp Univ A Coruna, Dept Rheumatol, La Coruna, Spain
Gonzalez-Alvarez, B:
Hosp Nuestra Senora Candelaria, Dept Rheumatol, Tenerife, Spain
Solans-Laque, R:
Hosp Valle De Hebron, Dept Internal Med, Barcelona, Spain
Rubio, J:
Hosp San Cecilio, Autoimmune Dis Unit, Granada, Spain
Ortego, N:
Hosp San Cecilio, Autoimmune Dis Unit, Granada, Spain
Fernandez-Diaz, C:
Hosp Univ Princesa, Dept Rheumatol, IIS Princesa, Madrid, Spain
Rubio, E:
Hosp Virgen Rocio, Autoimmune Dis Unit, Seville, Spain
Garcia-Morillo, S:
Hosp Virgen Rocio, Autoimmune Dis Unit, Seville, Spain
:
Hosp San Juan Alicante, Dept Rheumatol, Alicante, Spain
Fernandez C:
Hosp San Juan Alicante, Dept Rheumatol, Alicante, Spain
de Miguel, E:
Hosp Univ La Paz, Dept Rheumatol, Madrid, Spain
Melchor, S:
Hosp Univ 12 Octubre, Dept Rheumatol, Madrid, Spain
Salgado, E:
Complejo Hosp Univ Ourense, Dept Rheumatol, Orense, Spain
Bravo, B:
Hosp Virgen Nieves, Dept Rheumatol, Granada, Spain
Romero-Yuste, S:
Complejo Hosp Univ Pontevedra, Dept Rheumatol, Pontevedra, Spain
Salvatierra, J:
Hosp San Cecilio, Autoimmune Dis Unit, Granada, Spain
Hidalgo, C:
Complejo Univ Salamanca, Dept Rheumatol, Salamanca, Spain
Manrique, S:
Hosp Reg Malaga, Autoimmune Dis Unit, Malaga, Spain
Romero-Gomez, C:
Hosp Reg Malaga, Autoimmune Dis Unit, Malaga, Spain
Moya, P:
Hosp Santa Creu & Sant Pau, Dept Rheumatol, Barcelona, Spain
Alvarez-Rivas, N:
Hosp Univ San Agustin, Dept Rheumatol, Aviles, Spain
Mendizabal, J:
Complejo Hosp Navarra, Dept Rheumatol, Pamplona, Spain
Ortiz-Sanjuan, F:
Hosp Univ & Politecn La Fe, Dept Rheumatol, Valencia, Spain
de Pedro, I:
Hosp Carlos Haya, Autoimmune Dis Unit, Malaga, Spain
Alonso-Valdivielso, J:
Hosp Univ Burgos, Dept Rheumatol, Burgos, Spain
Perez-Sanchez, L:
Hosp Univ Reina Sofia, Dept Rheumatol, Cordoba, Spain
Roldan, R:
Hosp Univ Reina Sofia, Dept Rheumatol, Cordoba, Spain
:
Hosp Arnau Vilanova, Dept Rheumatol, Valencia, Spain
de la Torre, R:
Hosp Univ Cent Asturias, Autoimmune Dis Unit, Oviedo, Spain
Suarez, S:
Hosp Univ Cent Asturias, Autoimmune Dis Unit, Oviedo, Spain
Cabrera, M:
Hosp Nuestra Senora Candelaria, Dept Rheumatol, Tenerife, Spain
Sanchez, M:
Hosp Nuestra Senora Candelaria, Dept Rheumatol, Tenerife, Spain
Loricera, J:
Hosp Univ Marques de Valdecilla, Dept Rheumatol, IDIVAL, Res Grp Genet Epidemiol & Atherosclerosis Syst Di, Santander, Spain
Atienza-Mateo, B:
Hosp Univ Marques de Valdecilla, Dept Rheumatol, IDIVAL, Res Grp Genet Epidemiol & Atherosclerosis Syst Di, Santander, Spain
Castaneda, S:
Hosp Univ Princesa, Dept Rheumatol, IIS Princesa, Madrid, Spain
Univ Autonoma Madrid IUAMI, UAM ROCHE, EPID Future, Madrid, Spain
Gonzalez-Gay, M:
Hosp Univ Marques de Valdecilla, Rheumatol Div, Res Grp Genet Epidemiol & Atherosclerosis Syst Di, IDIVAL, Ave Valdecilla S-N, Santander 39008, Spain
Univ Cantabria, Sch Med, Santander, Spain
Univ Witwatersrand, Fac Hlth Sci, Sch Physiol, Cardiovasc Pathophysiol & Genom Res Unit, Johannesburg, South Africa
Blanco, R:
Hosp Univ Marques de Valdecilla, Dept Rheumatol, IDIVAL, Res Grp Genet Epidemiol & Atherosclerosis Syst Di, Santander, Spain
Green Published, gold
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