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Tocilizumab treatment effectively improves coronary artery involvement in patients with Takayasu arteritis

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Abstract

Objective

Coronary artery involvement in Takayasu arteritis (TAK) leads to poor prognosis and high mortality. Tocilizumab (TCZ) has been used to effectively treat large vessel vasculitis. However, the efficacy of TCZ in resolving coronary artery involvement in TAK is unclear. The aim of this retrospective study was to evaluate the efficacy of TCZ in the treatment of coronary artery involvement in TAK.

Methods

Clinical features and manifestations of coronary artery lesions in 11 TAK patients were evaluated before and after TCZ treatment, and the results were compared with those of 11 patients treated with traditional disease-modifying antirheumatic drugs (DMARDs).

Results

C-reactive protein (p = 0.006), erythrocyte sedimentation rate (ESR) (p = 0.011), and Kerr score (p = 0.007) were significantly decreased post-TCZ treatment for 6 months. The Indian Takayasu Clinical Activity Score (ITAS) 2010 (p = 0.019) and ITAS-A (p = 0.019) were significantly lower in patients treated with TCZ compared with those treated with traditional DMARDs. The glucocorticoid (GC) dose was tapered to 2.50 (0.00, 7.50) mg day−1 after TCZ treatment for 6 months, which was significantly lower than the GC dose after traditional DMARDs treatment [10.0 (5.00, 11.25) mg.day−1, (p = 0.033)]. After 6-month TCZ treatment, the total number of coronary artery lesions was reduced from 23 to 15 in 6 patients. Vascular wall thickening was remarkably improved in 2 lesions (in the ostia of the left main and right coronary arteries).

Conclusion

TCZ may decrease the disease activity and improve coronary artery lesion in patients with TAK.

Key Points

• TCZ treatment significantly decreased the disease activity in TAK patients with coronary artery involvement.

• TCZ treatment significantly reduces the dosage of GC.

• TCZ treatment led to an improvement in imaging findings of TAK patients with coronary artery involvement.

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Funding

This project was supported by grant from the National Natural Science Foundation of China (91739111). The sponsors did not have a role in the study design, data collection and analysis, decision to publish, or manuscript preparation.

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Authors and Affiliations

  1. Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Lili Pan, Juan Du & Hua Liao

  2. Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Jiayi Liu

  3. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China

    Xiaoli Liu, Jing Liang, Hongya Han, Lixia Yang & Yujie Zhou

  4. Department of Interventional Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Xi Guo

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  1. Lili Pan
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Contributions

LP conceived of the study and drafted the manuscript. JD, HL, JL, HH, and LY help to collected clinical data, XL help revised the manuscript, JL and XG evaluated the features of coronary CTA, Prof. Yujie Zhou guided the design of this study and modified the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yujie Zhou.

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Ethics approval and consent to participate

All subjects provided written informed consent. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and approved by the Clinical Research Ethics Board of Beijing Anzhen Hospital, Capital Medical University (approval number: 2019012X).

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The authors declare that there are no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Pan, L., Du, J., Liu, J. et al. Tocilizumab treatment effectively improves coronary artery involvement in patients with Takayasu arteritis. Clin Rheumatol 39, 2369–2378 (2020). https://doi.org/10.1007/s10067-020-05005-7

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  • DOI: https://doi.org/10.1007/s10067-020-05005-7

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