Yoshifuji Hajime
a Department of Rheumatology and Clinical Immunology , Graduate School of Medicine, Kyoto University , Sakyo-ku , Kyoto , Japan.
Mod Rheumatol. 2019 Mar;29(2):287-293. doi: 10.1080/14397595.2018.1546358. Epub 2019 Feb 4.
Takayasu arteritis (TAK) and giant cell arteritis (GCA) affect mainly large- and medium-sized arteries. In refractory cases, vascular remodeling progresses and leads to serious outcomes. Studies have demonstrated that cytokines such as interleukin (IL)-6 play crucial roles in the pathophysiology of TAK and GCA. Recently, randomized controlled trials on IL-6 inhibition therapy using tocilizumab (TCZ) were performed, and significant effects were exhibited. The purposes of conventional treatments have been to improve symptoms and decrease the levels of inflammatory markers. Arterial changes have been considered as damages. However, after TCZ came into practical use, establishment of treat to target is desired to prevent vascular remodeling. In contrast, a combination therapy of glucocorticoids (GCs) and TCZ notably increases the risk of infections. When TCZ is used, careful attention must be paid to possible infections, and dose of GC should be tapered as much as possible. Future tasks are to establish indication and dosage of TCZ, indication for discontinuation of TCZ due to remission, efficacy of TCZ monotherapy, and protocols of TCZ for pediatric cases.
高安动脉炎（TAK）和巨细胞动脉炎（GCA）主要累及大中动脉。在难治性病例中，血管重塑会进展并导致严重后果。研究表明，诸如白细胞介素（IL）-6等细胞因子在TAK和GCA的病理生理学中起关键作用。最近，开展了使用托珠单抗（TCZ）进行IL-6抑制治疗的随机对照试验，并显示出显著效果。传统治疗的目的一直是改善症状并降低炎症标志物水平。动脉变化一直被视为损害。然而，在TCZ实际应用后，期望建立目标治疗以预防血管重塑。相比之下，糖皮质激素（GCs）与TCZ的联合治疗显著增加感染风险。使用TCZ时，必须密切关注可能发生的感染，并且应尽可能减少GC的剂量。未来的任务是确定TCZ的适应证和剂量、因病情缓解而停用TCZ的指征、TCZ单药治疗的疗效以及儿童病例使用TCZ的方案。
