ABSTRACT: BACKGROUND: The interleukin (IL)-6 pathway is upregulated in giant cell arteritis (GCA), Takayasu arteritis (TAK), and polymyalgia rheumatica (PMR). We retrospectively assessed the outcomes of 10 patients with relapsing/refractory GCA, TAK, or PMR treated with tocilizumab (TCZ). METHODS: Patients with GCA (n=7), TAK (n=2), and PMR (n=1) received TCZ. Seven subjects had failed at least one second-line agent. The outcomes evaluated were symptoms of disease activity, inflammatory markers, ability to taper glucocorticoids (GC), and cross-sectional imaging when indicated clinically. RESULTS: The mean follow-up of this cohort since diagnosis was 27 months (range: 16-60). The patients received treatment with TCZ for a mean period of 7.8 months (range 4-12). Before TCZ, the patients experienced an average of 2.4 flares/year. All patients entered and maintained clinical remission during TCZ therapy. The mean daily prednisone doses before and after TCZ were 20.8 mg/day (range 7-34.3) and 4.1 mg/day (range 0-10.7), respectively (P=0.0001). The mean erythrocyte sedimentation rate (ESR) declined from 41.5 mm/h (range 11-68) to 7 mm/hr (range 2.2-11.3) (P=0.0001).TCZ adverse effects included mild neutropenia (n = 4) and transaminitis (n = 4). One patient flared 2 months after TCZ discontinuation. Autopsy on one patient who died from a post-operative myocardial infarction following elective surgery revealed persistent vasculitis of large- and medium-sized arteries. CONCLUSIONS: TCZ led to clinical and serological improvement in patients with refractory/relapsing GCA, TAK, or PMR. The demonstration of persistent large-vessel vasculitis at autopsy of one patient who had shown substantial response requires close scrutiny in larger studies.
Arthritis care & research. 06/2012;