Department of Rheumatology, Clinical Immunology & Allergology, University Hospital, University of Bern, Switzerland.
Swiss Med Wkly. 2011 Jan 17;141:w13156. doi: 10.4414/smw.2011.13156. eCollection 2011.
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.
评估使用托珠单抗阻断白细胞介素 6（IL-6）对大动脉血管炎（LVV）诱导缓解的疗效。
5 例巨细胞动脉炎（GCA）和 2 例 Takayasu 动脉炎（TA）患者接受托珠单抗输注（8mg/kg）。在前一个月，托珠单抗每两周给药一次，之后每月一次。前瞻性评估疾病活动的临床症状、红细胞沉降率（ESR）、C 反应蛋白（CRP）水平和维持缓解所需的糖皮质激素（GC）剂量。磁共振血管造影（MR 血管造影）用于监测局部炎症。
7 例患者中，3 例为新诊断，4 例为 GC 耐药，即 GC 不能降至 7.5mg/天以下。平均随访时间为 4.3 个月（范围 3-7 个月）。所有患者均迅速完全缓解临床症状，并使急性期蛋白恢复正常。值得注意的是，泼尼松剂量可在 12 周内降至平均 2.5mg/天（范围 0-10mg/天）。未出现复发和药物相关的副作用。
综合数据表明，使用托珠单抗阻断白细胞介素 6 可作为诱导大血管血管炎快速缓解的治疗选择。
