Schmalzing Marc, Gadeholt Ottar, Gernert Michael, Tony Hans-Peter, Schwaneck Eva C
Focus on Rheumatology / Clinical Immunology, Department of Internal Medicine II, University of Würzburg, 97080 Wurzburg, Germany.
Open Rheumatol J. 2018 Aug 31;12:152-159. doi: 10.2174/1874312901812010152. eCollection 2018.
Tocilizumab is increasingly used in the treatment of large vessel vasculitis with recent approval for giant cell arteritis.
To determine the efficacy and safety of tocilizumab in large vessel vasculitis in a real-life setting using different routes of administration.
Retrospective analysis of consecutive patients at a tertiary rheumatology department who received tocilizumab for large vessel vasculitis.
A total of 11 patients were treated with tocilizumab (8 giant cell arteritis, 2 large vessel vasculitis associated with rheumatoid arthritis, 1 Takayasu arteritis) after a median of 2 other steroid-sparing agents (range 1-4). Of these, 9 received tocilizumab as salvage therapy for active vasculitis and 2 due to the toxicity of their former steroid-sparing medication. After a mean follow-up of 23 months 7 patients were in remission as to vasculitis under a mean prednisolone dose of 1.7 ± 1.5 mg; one patient relapsed after long term remission having discontinued tocilizumab for elective surgery; one patient stopped tocilizumab after attributable infectious complications, and two patients died: one due to complications of vascular surgery, probably not attributable to tocilizumab; and the other due to sepsis secondary to sigmoiditis. Only 3 relapses occurred under continuous tocilizumab treatment. In all these 3 cases, renewed remission could be achieved by switching from subcutaneous (162 mg qw) to intravenous tocilizumab (8mg/kg q4w).
Tocilizumab is efficacious in patients with large vessel vasculitis in a real-life situation. Safety appears to be acceptable, but infectious complications have to be considered. Intravenous tocilizumab may be used in patients who relapse under subcutaneous application.
托珠单抗在治疗大血管血管炎中的应用日益增多，近期已获批用于治疗巨细胞动脉炎。
在现实环境中，使用不同给药途径确定托珠单抗治疗大血管血管炎的疗效和安全性。
对一家三级风湿病科连续接受托珠单抗治疗大血管血管炎的患者进行回顾性分析。
共有11例患者接受了托珠单抗治疗（8例巨细胞动脉炎，2例类风湿关节炎相关的大血管血管炎，1例高安动脉炎），之前平均使用过2种其他糖皮质激素节约剂（范围为1 - 4种）。其中，9例接受托珠单抗作为活动性血管炎的挽救治疗，2例因先前糖皮质激素节约药物的毒性而接受治疗。平均随访23个月后，7例患者的血管炎处于缓解状态，平均泼尼松龙剂量为1.7±1.5mg；1例患者在长期缓解后因择期手术停用托珠单抗而复发；1例患者因可归因的感染并发症而停用托珠单抗；2例患者死亡：1例死于血管手术并发症，可能与托珠单抗无关；另1例死于乙状结肠炎继发的败血症。在持续托珠单抗治疗下仅发生3次复发。在所有这3例病例中，从皮下注射（162mg每周一次）改为静脉注射托珠单抗（8mg/kg每4周一次）可再次实现缓解。
在现实情况下，托珠单抗对大血管血管炎患者有效。安全性似乎可以接受，但必须考虑感染并发症。皮下应用复发的患者可使用静脉注射托珠单抗。
