Takayasu arteritis (TA) is a chronic inflammatory disease of unknown etiology that involves large and medium-sized arteries, primarily the aorta and its major branches. TA is a therapeutic challenge because corticosteroids and conventional immunosuppressive agents are not always safe and/or efficacious. Interleukin 6 (IL-6) has emerged as a key cytokine in the pathogenesis of TA and its serum levels have been shown to well correlate with disease activity. We report the case of a normotensive, normolipemic 19 years old female patient with TA refractory to conventional immunosuppressive agents successfully treated by subcutaneous administration of tocilizumab. The follow-up period was 3.6 years. At the first evaluation, despite the current use of prednisone at dosage of (50 mg/kg/day), the patients presented with high clinical indices of disease activity, and high inflammatory markers; moreover, at the age of 22-years old, ultrasonography doppler scan diagnosed a severe atheromatous carotid involvement, with estimated stenosis of 75%, bilaterally; after tocilizumab was started, the patient was clinically and instrumentally evaluated every 16 weeks, and a progressive normalization of clinical and bio-humoral indices of disease was observed (stably normal since the 5th month of treatment); prednisone dosage could be consistently tapered and finally stopped since the 4th month of treatment. At the last US evaluation (6th month of treatment), carotid stenosis were estimated as 45%, bilaterally. At 12th month since the treatment has been started the carotid stenosis has been estimated lower than 25%, bilaterally. No significant side effects have been reported, and the patient is continuing to take the drug. Subcutaneous administration of tocilizumab appears a good option in refractory TA with an effective steroid-sparing effect. In addition, it seems to have very favorable effects on endothelial function improving cIMT, and significantly reducing artery hypertrophy.
SEVERE CAROTID ATHEROMATOUS STENOSIS REGRESSION AFTER SUBCUTANEOUS ADMINISTRATION OF TOCILIZUMAB
CAIRO, VALENTINA;LO GULLO, ALBERTO;ARAGONA, CATERINA ORIANA;Savarino, F;MAMONE, FEDERICA;Scuruchi, M;SARDO, Maria Adriana;Imbalzano, Egidio;CINQUEGRANI, Maurizio;MANDRAFFINO, GIUSEPPE
;SAITTA, Antonino
2016-01-01
Abstract
Takayasu arteritis (TA) is a chronic inflammatory disease of unknown etiology that involves large and medium-sized arteries, primarily the aorta and its major branches. TA is a therapeutic challenge because corticosteroids and conventional immunosuppressive agents are not always safe and/or efficacious. Interleukin 6 (IL-6) has emerged as a key cytokine in the pathogenesis of TA and its serum levels have been shown to well correlate with disease activity. We report the case of a normotensive, normolipemic 19 years old female patient with TA refractory to conventional immunosuppressive agents successfully treated by subcutaneous administration of tocilizumab. The follow-up period was 3.6 years. At the first evaluation, despite the current use of prednisone at dosage of (50 mg/kg/day), the patients presented with high clinical indices of disease activity, and high inflammatory markers; moreover, at the age of 22-years old, ultrasonography doppler scan diagnosed a severe atheromatous carotid involvement, with estimated stenosis of 75%, bilaterally; after tocilizumab was started, the patient was clinically and instrumentally evaluated every 16 weeks, and a progressive normalization of clinical and bio-humoral indices of disease was observed (stably normal since the 5th month of treatment); prednisone dosage could be consistently tapered and finally stopped since the 4th month of treatment. At the last US evaluation (6th month of treatment), carotid stenosis were estimated as 45%, bilaterally. At 12th month since the treatment has been started the carotid stenosis has been estimated lower than 25%, bilaterally. No significant side effects have been reported, and the patient is continuing to take the drug. Subcutaneous administration of tocilizumab appears a good option in refractory TA with an effective steroid-sparing effect. In addition, it seems to have very favorable effects on endothelial function improving cIMT, and significantly reducing artery hypertrophy.Pubblicazioni consigliate
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