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Observational Study
. 2023 Aug 2;25(1):137.
doi: 10.1186/s13075-023-03106-7.

High level of serum complement 3 is a risk factor for vascular stenosis progression in TA patients receiving tocilizumab: a prospective observational study

Chen Rongyi  1   2 , Dai Xiaojuan  1   2 , Wang Jinghua  1   2 , Ma Lingying  1   2 , Dai Xiaomin  1   2 , Ma Lili  1   2 , Chen Huiyong  3   4 , Jiang Lindi  5   6 , Sun Ying  7   8
Affiliations
Observational Study

High level of serum complement 3 is a risk factor for vascular stenosis progression in TA patients receiving tocilizumab: a prospective observational study

Chen Rongyi et al. Arthritis Res Ther. .

Abstract

Background: The IL-6R antibody tocilizumab has been proven effective in treating Takayasu arteritis (TA). However, some patients show silent vascular stenosis progression (VSP) despite treatment with tocilizumab. The aim of the study was to explore the related risk factors of VSP in patients treated with tocilizumab.

Methods: Patients receiving tocilizumab were enrolled from the prospective living ongoing East China Takayasu Arteritis cohort. Their medical information was uniformly recorded with a homogenized evaluation method. Magnetic resonant angiography or computed tomographic angiography was employed to monitor VSP during the follow-up period, and Cox regression analysis was performed to explore the related risk factors.

Results: Thirty-eight patients were enrolled, among whom 18 (47.4%) experienced VSP, and seven and three patients experienced new and worsened vascular ischemic symptoms and events (VISE) during follow-up, respectively. The median period for VSP occurrence was 6.9 months during follow-up. Patients with VSP showed higher levels of baseline complement 3 (C3) than those in the patients without VSP. Multivariate Cox regression analysis revealed baseline C3 level (hazard ratio [HR] = 7.05, 95% confidence interval: 1.50-33.07, p = 0.013) was independently associated with VSP, with a cut-off value of 1.22 g/L.

Conclusions: 47.4% of TA patients treated with tocilizumab would suffer VSP. A high C3 level is a risk factor for VSP in TA patients receiving tocilizumab, which may facilitate the option of tocilizumab in the future.

Keywords: Complement 3; Takayasu arteritis; Tocilizumab; Vascular stenosis progression.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The treatment effect of tocilizumab. A The NIH scores of enrolled patients at baseline and after 6 months of treatment. B The dose of prednisone in enrolled patients at baseline and positive treatment effect of tocilizumab. C representative image of VSP in TA. D The incidence of VSP and VISE during follow-up. ****p < 0.0001. TA, Takayasu arteritis; VSP, vascular stenosis progression; VISE, vascular ischemic symptoms and events
Fig. 2
Fig. 2
Dynamic changes in inflammatory markers during tocilizumab use in TA patients. A Dynamic changes in C3, C4, and CH50 in the 12 months of follow-up. B Dynamic changes in ESR, CRP, and IL-6 in the 12 months of follow-up. *Compared with baseline (0 month); *p < 0.05; **p < 0.01; ***p < 0.001; ****p < 0.0001. C3, complement 3; C4, complement 4; CH50, 50% hemolytic complement; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; IL-6, interleukin-6
Fig. 3
Fig. 3
Value of C3 in predicting VSP treated with tocilizumab in patients with TA. A ROC curves of C3 for identifying VSP in 1 year (cut-off level: 1.22 g/L). B Kaplan-Meir curves of VSP with respect to different C3 levels. C ROC curves of C3 for identifying VISE in 1 year (cut-off level: 1.0 g/L). D Kaplan-Meir curves of VISE with respect to different C3 levels. C3, complement 3; ROC, receiving operating characteristic; VSP, vascular stenosis progression; VISE, vascular ischemic symptoms and events
See this image and copyright information in PMC

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