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Tocilizumab in Large Vessel Vasculitis - Different Routes of Administration
Marc Schmalzing1, Ottar Gadeholt1, Michael Gernert1
1Focus on Rheumatology / Clinical Immunology, Department of Internal Medicine II, University of Würzburg, 97080 Wurzburg, Germany.
Background:
Tocilizumab is increasingly used in the treatment of large vessel vasculitis with recent approval for giant cell arteritis.
Objective:
To determine the efficacy and safety of tocilizumab in large vessel vasculitis in a real-life setting using different routes of administration.
Methods:
Retrospective analysis of consecutive patients at a tertiary rheumatology department who received tocilizumab for large vessel vasculitis.
Results:
A total of 11 patients were treated with tocilizumab (8 giant cell arteritis, 2 large vessel vasculitis associated with rheumatoid arthritis, 1 Takayasu arteritis) after a median of 2 other steroid-sparing agents (range 1-4). Of these, 9 received tocilizumab as salvage therapy for active vasculitis and 2 due to the toxicity of their former steroid-sparing medication. After a mean follow-up of 23 months 7 patients were in remission as to vasculitis under a mean prednisolone dose of 1.7 ± 1.5 mg; one patient relapsed after long term remission having discontinued tocilizumab for elective surgery; one patient stopped tocilizumab after attributable infectious complications, and two patients died: one due to complications of vascular surgery, probably not attributable to tocilizumab; and the other due to sepsis secondary to sigmoiditis. Only 3 relapses occurred under continuous tocilizumab treatment. In all these 3 cases, renewed remission could be achieved by switching from subcutaneous (162 mg qw) to intravenous tocilizumab (8mg/kg q4w).
Conclusion:
Tocilizumab is efficacious in patients with large vessel vasculitis in a real-life situation. Safety appears to be acceptable, but infectious complications have to be considered. Intravenous tocilizumab may be used in patients who relapse under subcutaneous application.
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