Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Department of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Rheumatol Int. 2019 Nov;39(11):1989-1994. doi: 10.1007/s00296-019-04390-w. Epub 2019 Aug 6.
Takayasu arteritis (TAK) is a subtype of the large-vessel vasculitis, affecting the aorta and its major branches. Although T cell-mediated autoimmunity is mainly involved in vascular inflammation, in recent years, accumulating evidence suggests the important role of B cells in the pathogenesis and effectiveness of B-cell-targeted therapy with rituximab (RTX), a chimeric anti-CD20 monoclonal antibody in refractory TAK. Herein, we report for the first time a case involving a 34-year-old man with TAK who was refractory to four different biologic agents, such as one selective T-cell co-stimulation modulator (abatacept), one anti-interleukin-6 receptor monoclonal antibody (tocilizumab), and two tumor necrosis factor-α inhibitors (infliximab and etanercept), but eventually achieved remission with RTX. He received a total of six courses of RTX, and doses of prednisolone and methotrexate were tapered without relapse. The current case provided further evidence to the potential role of RTX therapy in patients with refractory TAK, and its efficacy needs to be validated in a controlled trial.
Takayasu 动脉炎（TAK）是大动脉炎的一个亚型，影响主动脉及其主要分支。尽管 T 细胞介导的自身免疫主要涉及血管炎症，但近年来，越来越多的证据表明 B 细胞在发病机制和利妥昔单抗（RTX）疗效中起重要作用，RTX 是一种嵌合抗 CD20 单克隆抗体，用于难治性 TAK。在此，我们首次报告了一例 34 岁男性 TAK 患者，他对四种不同的生物制剂（如一种选择性 T 细胞共刺激调节剂（阿巴西普）、一种抗白细胞介素 6 受体单克隆抗体（托珠单抗）和两种肿瘤坏死因子-α抑制剂（英夫利昔单抗和依那西普））均无反应，但最终用 RTX 缓解。他总共接受了六轮 RTX 治疗，同时逐渐减少泼尼松龙和甲氨蝶呤的剂量，没有复发。目前的病例为 RTX 治疗难治性 TAK 患者的潜在作用提供了进一步的证据，其疗效需要在对照试验中进一步验证。
