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Clinical Rheumatology
Published in: Clinical Rheumatology 8/2020

01-08-2020 | Tocilizumab | Original Article

Tocilizumab treatment effectively improves coronary artery involvement in patients with Takayasu arteritis

Authors: Lili Pan, Juan Du, Jiayi Liu, Hua Liao, Xiaoli Liu, Xi Guo, Jing Liang, Hongya Han, Lixia Yang, Yujie Zhou

Published in: Clinical Rheumatology | Issue 8/2020

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Abstract

Objective

Coronary artery involvement in Takayasu arteritis (TAK) leads to poor prognosis and high mortality. Tocilizumab (TCZ) has been used to effectively treat large vessel vasculitis. However, the efficacy of TCZ in resolving coronary artery involvement in TAK is unclear. The aim of this retrospective study was to evaluate the efficacy of TCZ in the treatment of coronary artery involvement in TAK.

Methods

Clinical features and manifestations of coronary artery lesions in 11 TAK patients were evaluated before and after TCZ treatment, and the results were compared with those of 11 patients treated with traditional disease-modifying antirheumatic drugs (DMARDs).

Results

C-reactive protein (p = 0.006), erythrocyte sedimentation rate (ESR) (p = 0.011), and Kerr score (p = 0.007) were significantly decreased post-TCZ treatment for 6 months. The Indian Takayasu Clinical Activity Score (ITAS) 2010 (p = 0.019) and ITAS-A (p = 0.019) were significantly lower in patients treated with TCZ compared with those treated with traditional DMARDs. The glucocorticoid (GC) dose was tapered to 2.50 (0.00, 7.50) mg day−1 after TCZ treatment for 6 months, which was significantly lower than the GC dose after traditional DMARDs treatment [10.0 (5.00, 11.25) mg.day−1, (p = 0.033)]. After 6-month TCZ treatment, the total number of coronary artery lesions was reduced from 23 to 15 in 6 patients. Vascular wall thickening was remarkably improved in 2 lesions (in the ostia of the left main and right coronary arteries).

Conclusion

TCZ may decrease the disease activity and improve coronary artery lesion in patients with TAK.
Key Points
• TCZ treatment significantly decreased the disease activity in TAK patients with coronary artery involvement.
• TCZ treatment significantly reduces the dosage of GC.
• TCZ treatment led to an improvement in imaging findings of TAK patients with coronary artery involvement.
Literature
1.
2.
Park MC, Lee SW, Park YB, Chung NS, Lee SK (2005) Clinical characteristics and outcomes of Takayasu’s arteritis: analysis of 108 patients using standardized criteria for diagnosis, activity assessment, and angiographic classification. Scand J Rheumatol 34(4):284–292CrossRefPubMed
3.
Hlavaty L, Diaz F, Sung L (2015) Takayasu arteritis of the coronary arteries presenting as sudden death in a white teenager. Am J Forensic Med Pathol 36(3):221–223CrossRefPubMed
4.
Spagnolo EV, Cannavo G, Mondello C, Cardia L, Bartoloni G, Cardia G (2015) Unexpected death for Takayasu aortitis associated with coronary ostial stenosis: case report. Am J Forensic Med Pathol 36(2):88–90CrossRefPubMed
5.
Li J, Li H, Sun F, Chen Z, Yang Y, Zhao J, Li M, Tian X, Zeng X (2017) Clinical characteristics of heart involvement in Chinese patients with Takayasu arteritis. J Rheumatol 44:1867–1874CrossRefPubMed
6.
Soto ME, Melendez-Ramirez G, Kimura-Hayama E, Meave-Gonzalez A, Achenbach S, Herrera MC, Guering EL, Alexanderson-Rosas E, Reyes PA (2011) Coronary CT angiography in Takayasu arteritis. JACC Cardiovasc Imaging 4(9):958–966CrossRefPubMed
7.
Kang EJ, Kim SM, Choe YH, Lee GY, Lee KN, Kim DK (2014) Takayasu arteritis: assessment of coronary arterial abnormalities with 128-section dual-source CT angiography of the coronary arteries and aorta. Radiology 270(1):74–81CrossRefPubMed
8.
Wang X, Dang A, Lv N, Cheng N, Cheng X, Yang Y, Song Y (2017) Long-term outcomes of coronary artery bypass grafting versus percutaneous coronary intervention for Takayasu arteritis patients with coronary artery involvement. Semin Arthritis Rheum 47(2):247–252CrossRefPubMed
9.
Mukhtyar C, Guillevin L, Cid MC, Dasgupta B, de Groot K, Gross W, Hauser T, Hellmich B, Jayne D, Kallenberg CG, Merkel PA, Raspe H, Salvarani C, Scott DG, Stegeman C, Watts R, Westman K, Witter J, Yazici H, Luqmani R, European Vasculitis Study Group (2009) EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 68(3):318–323CrossRefPubMed
10.
Park MC, Lee SW, Park YB, Lee SK (2006) Serum cytokine profiles and their correlations with disease activity in Takayasu’s arteritis. Rheumatology (Oxford) 45(5):545–548CrossRefPubMed
11.
Kong X, Sun Y, Ma L, Chen H, Wei L, Wu W, Ji Z, Zhang Z, Zhao Z, Hou J et al (2016) The critical role of IL-6 in the pathogenesis of Takayasu arteritis. Clin Exp Rheumatol 34(3 Suppl 97):S21–S27PubMed
12.
Kong X, Ma L, Ji Z, Dong Z, Zhang Z, Hou J, Zhang S, Jiang L (2017) Pro-fibrotic effect of IL-6 via aortic adventitial fibroblasts indicates IL-6 as a treatment target in Takayasu arteritis. Clin Exp Rheumatol 36(1):62–72
13.
Stone JH, Klearman M, Collinson N (2017) Trial of Tocilizumab in giant-cell arteritis. N Engl J Med 377(15):1494–1495PubMed
14.
Villiger PM, Adler S, Kuchen S, Wermelinger F, Dan D, Fiege V, Butikofer L, Seitz M, Reichenbach S (2016) Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet 387(10031):1921–1927CrossRefPubMed
15.
Nakaoka Y, Isobe M, Takei S, Tanaka Y, Ishii T, Yokota S, Nomura A, Yoshida S, Nishimoto N (2018) Efficacy and safety of tocilizumab in patients with refractory Takayasu arteritis: results from a randomised, double-blind, placebo-controlled, phase 3 trial in Japan (the TAKT study). Ann Rheum Dis 77(3):348–354CrossRefPubMed
16.
Zhou J, Chen Z, Li J, Yang Y, Zhao J, Chen H, Liu M, Sun F, Li M, Tian X et al (2017) The efficacy of tocilizumab for the treatment of Chinese Takayasu’s arteritis. Clin Exp Rheumatol 35 Suppl 103(1):171–175PubMed
17.
Kleveland O, Kunszt G, Bratlie M, Ueland T, Broch K, Holte E, Michelsen AE, Bendz B, Amundsen BH, Espevik T, Aakhus S, Damås JK, Aukrust P, Wiseth R, Gullestad L (2016) Effect of a single dose of the interleukin-6 receptor antagonist tocilizumab on inflammation and troponin T release in patients with non-ST-elevation myocardial infarction: a double-blind, randomized, placebo-controlled phase 2 trial. Eur Heart J 37(30):2406–2413CrossRefPubMed
18.
Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RY, Lie JT, Lightfoot RW Jr et al (1990) The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 33(8):1129–1134CrossRefPubMed
19.
Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, Hoffman GS (1994) Takayasu arteritis. Ann Intern Med 120(11):919–929CrossRefPubMed
20.
Misra R, Danda D, Rajappa SM, Ghosh A, Gupta R, Mahendranath KM, Jeyaseelan L, Lawrence A, Bacon PA (2013) Development and initial validation of the Indian Takayasu clinical activity score (ITAS2010). Rheumatology (Oxford) 52(10):1795–1801CrossRefPubMed
21.
Hata A, Noda M, Moriwaki R, Numano F (1996) Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol 54(Suppl):S155–S163CrossRefPubMed
22.
Miloslavsky E, Unizony S (2014) The heart in vasculitis. Rheum Dis Clin N Am 40(1):11–26CrossRef
23.
Rav-Acha M, Plot L, Peled N, Amital H (2007) Coronary involvement in Takayasu’s arteritis. Autoimmun Rev 6(8):566–571CrossRefPubMed
24.
van der Goes MC, Jacobs JW, Bijlsma JW (2014) The value of glucocorticoid co-therapy in different rheumatic diseases--positive and adverse effects. Arthritis Res Ther 16(Suppl 2):S2CrossRefPubMedPubMedCentral
25.
Kondo T, Amano K (2018) Era of steroid sparing in the management of immune-mediated inflammatory diseases. Immunol Med 41(1):6–11CrossRefPubMed
26.
Banerjee S, Bagheri M, Sandfort V, Ahlman MA, Malayeri AA, Bluemke DA, Yao J, Grayson PC (2018) Vascular calcification in patients with large-vessel vasculitis compared to patients with hyperlipidemia. Semin Arthritis Rheum 48(6):1068–1073
27.
Mekinian A, Resche-Rigon M, Comarmond C, Soriano A, Constans J, Alric L, Jego P, Busato F, Cabon M, Dhote R et al (2018) Efficacy of tocilizumab in Takayasu arteritis: multicenter retrospective study of 46 patients. J Autoimmun 91:55–60CrossRefPubMed
28.
Kong X, Zhang X, Lv P, Cui X, Ma L, Chen H, Liu H, Lin J, Jiang L (2018) Treatment of Takayasu arteritis with the IL-6R antibody tocilizumab vs. cyclophosphamide. Int J Cardiol 266:222–228CrossRefPubMed
29.
Yokokawa T, Kunii H, Kaneshiro T, Ichimura S, Yoshihisa A, Yashiro Furuya M, Asano T, Nakazato K, Ishida T, Migita K, Takeishi Y (2019) Regressed coronary ostial stenosis in a young female with Takayasu arteritis: a case report. BMC Cardiovasc Disord 19(1):79CrossRefPubMedPubMedCentral
30.
Romano C, Del Mastro A, Sellitto A, Solaro E, Esposito S, Cuomo G (2018) Tocilizumab reduces complement C3 and C4 serum levels in rheumatoid arthritis patients. Clin Rheumatol 37(6):1695–1700CrossRefPubMed
31.
de Carvalho JF, Bonfa E, Bezerra MC, Pereira RM (2009) High frequency of lipoprotein risk levels for cardiovascular disease in Takayasu arteritis. Clin Rheumatol 28(7):801–805CrossRefPubMed
32.
Wang X, Chen B, Lv N, Liu Q, Dang A (2015) Association of abnormal lipid spectrum with the disease activity of Takayasu arteritis. Clin Rheumatol 34(7):1243–1248CrossRefPubMed
33.
Ferraz-Amaro I, Hernandez-Hernandez MV, Tejera-Segura B, Delgado-Frias E, Macia-Diaz M, Machado JD, Diaz-Gonzalez F (2019) Effect of IL-6 receptor blockade on proprotein convertase subtilisin/Kexin Type-9 and cholesterol efflux capacity in rheumatoid arthritis patients. Horm Metab Res 51(3):200–209CrossRefPubMed
34.
35.
Hellmich B, Agueda A, Monti S, Buttgereit F, de Boysson H, Brouwer E, Cassie R, Cid MC, Dasgupta B, Dejaco C et al (2019) 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 79(1):19–30
Metadata
Title
Tocilizumab treatment effectively improves coronary artery involvement in patients with Takayasu arteritis
Authors
Lili Pan
Juan Du
Jiayi Liu
Hua Liao
Xiaoli Liu
Xi Guo
Jing Liang
Hongya Han
Lixia Yang
Yujie Zhou
Publication date
01-08-2020
Publisher
Springer International Publishing
Published in
Clinical Rheumatology / Issue 8/2020
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-020-05005-7

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