Interleukin-6 inhibitionwithtocilizumabfortreatment oflargevessel vasculitis with severe comorbidity

Takayasu’s arteritis (TAK) and giant cell arteritis (GCA) are the two most common types of large vessel vasculitis (LVV). The progress in understanding the mechanisms of the diseases, and the introduction of biological agents in rheumatology practice made it possible to develope a new LVV pharmacotherapy using interleukin 6 (IL-6) inhibition. In 2017, tocilizumab (TCZ) was approved for the treatment of GCA in the US and Europe based on the results of two randomized clinical trials,. The authors describe their own series of ten cases of TCZ administration for complicated LVV (8 GCA and 2 TAK) with severe comorbid disorders that increase the risk of adverse effects of glucocorticoids (GC). All patients had a good clinical response to TCZ 2.3-8.8 mg/kg/month for 1-10 months with achieving remission (8/10) or improvement (2/10). Relapses after TCZ withdrawal developed in 3 patients (1 GCA and 2 TAK), but after the resumption of TCZ in two cases was again in remission. TCZ was well tolerated, and GC dose reduction was possible in all cases. There was one serious adverse event (olecranon purulent bursitis). IL-6 inhibitors should be considered as a potentially effective and relatively safe treatment for LVV, primarily GCA, in patients with comorbidity, intolerance or contraindications to standard therapy.

Key words

Giant cell arteritis, Takayasu’s arteritis, interleukin-6, tocilizumab.