Saunier Aurélie, Issa Nahéma, Vandenhende Marie-Anne, Morlat Philippe, Doutre Marie-Sylvie, Bonnet Fabrice
Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France.
Service de Dermatologie, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France.
RMD Open. 2017 Jun 29;3(1):e000446. doi: 10.1136/rmdopen-2017-000446. eCollection 2017.
We describe the effect of interleukin 6 (IL-6) blockade using tocilizumab (TCZ) for inducing and maintaining remission of refractory polyarteritis nodosa (PAN). Three patients with refractory PAN defined according to the American College of Rheumatology criteria were treated with TCZ infusions (8 mg/kg) on a monthly basis. All of them had severe cutaneous and articular involvement with elevated biological inflammatory markers. One suffered from a neuritis multiplex and one from renal and digestive damage. All three patients were dependent on high doses of glucocorticoids (above 0.5 mg/kg) and two of them were resistant to immunosuppressive drugs. All patients achieved and maintained clinical response and normalisation of the inflammation acute-phase proteins after a few weeks of treatment with TCZ. Prednisolone could be reduced by an average of 41-13 mg/day. These first case reports suggest that IL-6 blockade using TCZ could be a therapeutic alternative to induce remission in patients with polyarteritis nodosa resistant or intolerant to the reference treatment.
我们描述了使用托珠单抗（TCZ）阻断白细胞介素6（IL-6）对诱导和维持难治性结节性多动脉炎（PAN）缓解的效果。根据美国风湿病学会标准定义的3例难治性PAN患者接受每月一次的TCZ输注（8mg/kg）治疗。他们均有严重的皮肤和关节受累，生物炎症标志物升高。1例患有多发性神经炎，1例有肾脏和消化系统损害。所有3例患者均依赖高剂量糖皮质激素（超过0.5mg/kg），其中2例对免疫抑制药物耐药。所有患者在接受TCZ治疗几周后均实现并维持了临床缓解以及炎症急性期蛋白正常化。泼尼松龙剂量平均可减少41-13mg/天。这些首例病例报告表明，对于对参考治疗耐药或不耐受的结节性多动脉炎患者，使用TCZ阻断IL-6可能是诱导缓解的一种治疗选择。
