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Circulation. 2015 Nov 3;132(18):1693-700. doi: 10.1161/CIRCULATIONAHA.114.014321. Epub 2015 Sep 9.

Efficacy of Biological-Targeted Treatments in Takayasu Arteritis: Multicenter, Retrospective Study of 49 Patients.

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1
From AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France (A.M., O.F.); Service de Médecine Interne, Hôpital Pitié Salpetrière, Université Paris 6, Paris, France (C.C., P. Cacoub, D.S.); Unité Epidémiologie et Biostatistiques, INSERM, Hôpital Saint Louis, Paris, France (M.R.-R.); Service de Médecine Vasculaire, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris-APHP, Université Paris Descartes, Sorbonne Paris Cité, PARCC, Inserm U970, Centre de Référence National Maladies Vasculaires Rares, Paris, France (T.M., E.M.); Service de Médecine Interne, Hôpital Foch, Université Versailles Saint Quentin en Yvelines, Versailles, France (J.E.K.); Service de Médecine Interne, CHU Lille, Université Lille II, Lille, France (M.L.); Inserm UMR_1109, Fédération de Médecine Translationnelle, Université de Strasbourg, Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (J.S.); Service de Médecine Interne, CHU Hôtel-Dieu, Nantes, France (A.N., M. Hamidou); Université Paris Descartes, AP-HP, Hôpital Cochin, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Service de Médecine Interne, Paris, France (P. Cohen, L.G.); Service de Médecine Interne, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology Groupe Hospitalier Pitié-Salpetrière, Université Pierre et Marie Curie, UPMC, Paris, France (M. Hie, Z.A.); Service de Médecine Interne et Immunologie Clinique, Hôpital le Bocage, Dijon, France (S.B.); Service de Médecine Interne, Université Rouen, Rouen, France (I.M.); Service de Médecine Interne et Maladies Vasculaires, Centre de Compétence de Maladies Rares, CHU Angers, Université Angers, Angers, France (C.L.); Service de Médecine Interne, Université Bordeaux, CHU Bordeaux, Bordeaux, France (M.A.V.); Service de Médecine Interne et Immunologie Clinique, Universi

Abstract

BACKGROUND:

The goal of this work was to assess the safety and efficacy of biologics (ie, tumor necrosis factor-α antagonists and tocilizumab) in patients with Takayasu arteritis.

METHODS AND RESULTS:

This was a retrospective, multicenter study of the characteristics and outcomes of 49 patients with Takayasu arteritis (80% female; median age, 42 years [20-55 years] treated by tumor necrosis factor-α antagonists [80%] or tocilizumab [20%]) and fulfilling American College of Rheumatology or Ishikawa criteria. Factors associated with complete response were assessed. Eighty-eight percent of patients with Takayasu arteritis were inadequately controlled with or were intolerant to conventional immunosuppressive therapy (median number, 3 [1-5]). Overall response (ie, complete and partial) to biological-targeted treatments at 6 and 12 months was 75% and 83%, respectively. There were significantly lower C-reactive protein levels at the initiation of biological-targeted treatments (22 mg/L [10-46 mg/L] versus 58 mg/L [26-76 mg/L]; P=0.006) and a trend toward fewer immunosuppressants drugs used before biologics (P=0.054) in responders (ie, complete or partial responders) relative to nonresponders to biological-targeted treatments. C-reactive protein levels and daily prednisone dose significantly decreased after 12 months of biological-targeted treatments (30 versus 6 mg/L [P<0.05] and 15 versus 7.5 mg [P<0.05] at baseline and 12 months, respectively). The 3-year relapse-free survival was 90.9% (83.5%-99%) over the biological treatment period compared with 58.7% (43.3%-79.7%; P=0.0025) with disease-modifying antirheumatic drugs. No difference in efficacy was found between tumor necrosis factor-α antagonists and tocilizumab. After a median follow-up of 24 months (2-95 months), 21% of patients experienced adverse effects, with biological-targeted treatments discontinued in 6.6% of cases.

CONCLUSION:

This nationwide study shows a high efficacy of biological-targeted treatments in refractory patients with Takayasu arteritis with an acceptable safety profile.

KEYWORDS:

Takayasu arteritis; biological therapy; treatment outcome; vasculitis

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