Rapid induction of remission in large vessel vasculitis by IL-6 blockade
OBJECTIVE: To evaluate the effect of IL-6 blockade using tocilizumab in inducing remission of arterial large vessel vasculitides (LVV).
METHODS: 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.
RESULTS: 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.
CONCLUSION: Collectively the data suggest that IL-6 blockade using tocilizumab qualifies as a therapeutic option to induce rapid remission in large vessel vasculitides.
- Gonzàles-Gay MA, Garcia-Porruea C. Epidemiology of the vasculitides. Rheum Dis Clin North Am. 2001;27:729–49.
- Gonzàles-Gay MA, Garcia-Porrua C, Llorca J, Hajeer AH, Branas F, Dababneh A, et al. Visual manifestations of giant cell arteritis. Trends and clinical spectrum in 161 patients. Medicine. (Baltimore) 2000;79:283–92.
- Proven A, Gabriel SE, Orces C, O’Fallon WM, Hunder GG. Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Rheum. 2003;49:703–8.
- Jover JA, Hernandez-Garcia C, Morado IC, Banares A, Fernandez-Gutiérrez B. Combined treatment of giant cell arteritis with methotrexate and prednisone: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2001;134:106–14.
- Mahr AD, Jover JA, Spiera RF, Hernandez-Garcia C, Fernandez-Gutierrez B, La Valley MP. Merkel PA. Adjunctive Methotrexate for treatment of giant cell arteritis. An individual patient data meta-analysis. Arthritis Rheum. 2007;56:2789–97.
- De Silva M, Hazleman BL. Azathioprine in giant cell arteritis/polymyalgia rheumatic: a double-blind study. Ann Rheum Dis. 1986;45:136–8.
- Martínez-Taboada VM, Rodríguez-Valverde V, Carreño L, López-Longo J, Figueroa M, Belzunegui J, et al. A double-blind placebo controlled trial of etanercept in giant cell arteritis and corticosteroid side effects. Ann Rheum Dis. 2008;67:625–30.
- Hoffmann GS, Cid MC, Rendt-Zagar K, Merkel PA, Weyand CM, Stone JH, et al. Infliximab for maintenance of glucocorticosteroid-induced remission of giant cell arteritis. Ann Int Med. 2007;146:621–30.
- Emilie D, Liozon E, Crevon MC, Lavignac C, Portier A, Liozon F, et al. Production of interleukin 6 by granulomas of giant cell arteritis. Hum Immunol. 1994;39:17–24.
- Roche NE, Fulbright JW, Wagner AD, Hunder GG, Goronzy JJ, Weyand CM. Correlation of interleukin-6 production and disease activity in polymyalgia rheumatica and giant cell arteritis. Arthritis Rheum. 1993;36:1286–94.
- Park MC, Lee SW, Park YB, Lee SK. Serum cytokine profiles and their correlations with disease activity in Takayasu’s arteritis. Rheumatology. 2006;45:545–8.
- Nishimoto N, Nakahara H, Yoshio-Hoshino N, Mima T. Successful treatment of a patient with Takayasu arteritis using a humanized anti-interleukin-6 receptor antibody. Arthritis Rheum. 2008;58:1197–200.
- Hunder GG, Bloch DA, Michel BA, Stevens MB, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 Criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990;33:1122–8.
- Arend WP, Michael BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, et al. The American College of Rheumatology 1990 Criteria for the Classification of Takayasu arteritis. Arthritis Rheum. 1990;33:1129–34.
- Smolen JS, Beaulieu A, Rubbert-Roth A, Ramos-Remus C, Rovensky J, Alecock E, Woodworth T, Alten R, for the OPTION Investigators. Effect of interleukin-6 receptor inhibition with tocilizumab in patients with rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomized trial. Lancet. 2008;371:987–97.