Shirai Tsuyoshi, Ishii Tomonori, Okazaki Soshi, Shirota Yuko, Ishii Yusho, Sato Hiroko, Fujii Hiroshi
Department of Clinical Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Front Immunol. 2025 Jan 7;15:1473100. doi: 10.3389/fimmu.2024.1473100. eCollection 2024.
The feasibility of corticosteroid withdrawal (CW) for Takayasu arteritis (TAK) remains uncertain. Two autoantibodies (Abs) are identified against endothelial protein C receptor (EPCR) and scavenger receptor class B type 1 (SR-BI) in TAK, determining its three subgroups. This study aimed to evaluate CW using tocilizumab (TCZ) and its association with the Ab profile.
This prospective study, lasted for 24 weeks, included patients with relapsed but stable TAK. Scheduled tapering of prednisolone (PSL) was performed with subcutaneous TCZ (CW at week 20). The primary endpoint was the difference in type A remission, defined by CW and the absence of inflammatory signs, according to the Ab profile at week 24.
Twenty patients were included and 18 patients with a mean PSL dose of 4.9 ± 2.8 mg/day were analysed. Anti-EPCR Ab-positive (E+), anti-SR-BI Ab-positive (S+), and double-negative (DN) groups included four (22.2%), eight (44.4%), and six (33.3%) patients, respectively. At week 24, the mean PSL dose was 2.0 ± 2.7 mg/day. Type A remission was observed in eight patients (44.4%), with significant differences based on the Ab profile: E+ (three patients, 75%), S+ (five patients, 62.5%), and DN (zero patients, 0%) (P=0.018). Besides, age, disease duration, PSL dose, type V arterial lesion, arterial dilation, and C-reactive protein >0.01 mg/dL were identified as risks for CW failure.
CW using TCZ was achieved in 44.4% of patients with TAK relapse and was significantly higher in E+ and S+ patients. CW can be a feasible target, and the precise selection of patients is critical.
糖皮质激素撤减（CW）用于大动脉炎（TAK）的可行性仍不确定。在TAK中鉴定出两种针对内皮蛋白C受体（EPCR）和B类I型清道夫受体（SR-BI）的自身抗体（Abs），据此确定了TAK的三个亚组。本研究旨在评估使用托珠单抗（TCZ）进行CW及其与抗体谱的相关性。
这项为期24周的前瞻性研究纳入了复发但病情稳定的TAK患者。采用皮下注射TCZ进行泼尼松龙（PSL）的计划性减量（第20周进行CW）。主要终点是根据第24周时的抗体谱，由CW和无炎症体征所定义的A型缓解差异。
纳入20例患者，分析了18例平均PSL剂量为4.9±2.8mg/天的患者。抗EPCR抗体阳性（E+）、抗SR-BI抗体阳性（S+）和双阴性（DN）组分别有4例（22.2%）、8例（44.4%）和6例（33.3%）患者。在第24周时，平均PSL剂量为2.0±2.7mg/天。8例患者（44.4%）观察到A型缓解，根据抗体谱存在显著差异：E+组（3例患者，75%）、S+组（5例患者，62.5%）和DN组（0例患者，0%）（P=0.018）。此外，年龄、病程、PSL剂量、V型动脉病变、动脉扩张和C反应蛋白>0.01mg/dL被确定为CW失败的风险因素。
44.4%的TAK复发患者通过使用TCZ实现了CW，E+和S+患者的CW率显著更高。CW可以是一个可行的目标，精确选择患者至关重要。
