Comparative Effectiveness of Tocilizumab and Tumor Necrosis Factor Inhibitors in Takayasu Arteritis: Age-Related...

Comparative, prospective data on biologics for Takayasu arteritis (TAK) are limited. We compared tumor necrosis factor inhibitors (TNFi) and tocilizumab (TCZ) in a combined cohort, assessed demographic and cytokine influences, and evaluated longitudinal outcomes.

Clinical response to TNFi or TCZ was assessed in patients with TAK from two independent cohorts. In a subset followed prospectively within a standardized research protocol, physician global assessment (PGA), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) activity were compared pretreatment and posttreatment. Time to response was analyzed using Kaplan-Meier curves. Cytokine levels were measured with Luminex assays in patients and age-matched healthy controls.

Among 151 patients (cohort A = 57; cohort B = 94), 129 received TNFi and 56 received TCZ during follow-up. Clinical response rates were 72.1% for TNFi and 60.7% for TCZ (P = 0.17). In the prospective subset, no significant differences in PGA, CRP, ESR, or FDG-PET outcomes (P > 0.30) were observed. Changing to another TNFi or switching between TNFi or TCZ after treatment failure resulted in clinical response in 31 of 33 (94%) patients. TNFi responders had a younger median age at onset than nonresponders (23 vs 33.5 years, P = 0.0039), whereas TCZ responders were older (35 vs 21.5 years, P = 0.0043). Patients with onset <30 years showed elevated interleukin-6 and TNF versus controls, a pattern not observed in older patients.

TNFi and TCZ demonstrated similar effectiveness in TAK. These findings support therapeutic switching after treatment failure and suggest that age-related immunologic differences may influence treatment response.