Tocilizumab in treatment-naïve patients with Takayasu arteritis: TOCITAKA French prospective multicenter open-labeled trial

Abstract

Objectives: To assess long-term efficacy of tocilizumab in treatment-naive patients with Takayasu arteritis (TAK).

Methods: Prospective open-labeled trial in naïve patients with TAK who received steroids at the dose of 0.7 mg/kg/day and 7 infusions of 8 mg/kg/month of tocilizumab. The primary endpoint was the number of patients who discontinued steroids after 7 infusions of tocilizumab. Secondary endpoints included disease activity and the number of relapses during 18-month follow-up.

Results: Thirteen patients with TAK were included, with a median age of 32 years [19-45] and 12 (92%) females. Six (54%) patients met the primary end-point. A significant decrease of disease activity was observed after 6 months of tocilizumab therapy: decrease of median NIH scale (3 [3, 4] at baseline, versus 1 [0-2] after 6 months; p < 0.001), ITAS-2010 score (5 [2-7] versus 3 [0-8]; p = 0.002), and ITAS-A score (7 [4-10] versus 4 [1-15]; p = 0.0001)]. During the 12-month follow-up after tocilizumab discontinuation, a relapse occurred among 5 patients (45%) out of 11 in which achieved remission after 6 months of tocilizumab.

Conclusion: Tocilizumab seems an effective steroid sparing therapy in TAK, but maintenance therapy is necessary.

Trial registration: ClinicalTrials.gov NCT02101333 . Registered on 02 April 2014.

Keywords: Takayasu arteritis; Tocilizumab; Vasculitis treatment.

Fig. 1

TOCITAKA trial data of steroids sparing effect and relapse rates after 6-month tocilizumab therapy. a Steroids amounts during the 18-month follow-up in TOCITAKA trial. b Frequencies of relapse after 6-month tocilizumab induction therapy, represented as cumulative proportion of patients in remission and with relapsing-persistent TAK disease at months 3, 6, 9, and 12 after the tocilizumab discontinuation