RESEARCH ARTICLE


Tocilizumab in Large Vessel Vasculitis – Different Routes of Administration



Marc Schmalzing*, Ottar Gadeholt, Michael Gernert, Hans-Peter Tony, Eva C Schwaneck
Focus on Rheumatology / Clinical Immunology, Department of Internal Medicine II, University of Würzburg, 97080 Wurzburg, Germany


© 2018 Schmalzing et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address for correspondence to this author at the Department of Internal Medicine II, University Hospital Würzburg, Rheumatology /Clinical Immunology, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; Tel: +49 931 201 40100; Fax: +49 0931 201 640100; E-mail: Schmalzing_m@ukw.de


Abstract

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.

Keywords: Tocilizumab, Giant cell arteritis, Takayasu arteritis, Route of administration, Infections, Subcutaneous, Intravenous.