THU0452 Anti-interleukin-6 (TOCILIZUMAB) experience in takayasu’s arteritis patients
Authors: L. Kilic, O. Karadag, A. Erden, A. Sari, B. Armagan, E. Firat, U. Kalyoncu, S. Apras Bilgen, S. Kiraz, I. Ertenli, A. Akdogan
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Targeted therapies such as tumour necrosis factor inhibitors (TNFi) and anti-interleukin 6 (anti-IL-6) are increasingly being used in Takayasu's Arteritis (TA) patients who are unresponsive to corticosteroids±conventional immunosuppressives. <h3>Objectives</h3> The aim of this study was to evaluate the indications and efficacy of anti-IL-6 (tocilizumab) therapy in a case series of TA patients. <h3>Methods</h3> In the prospective database of the Hacettepe University Vasculitis Centre (HUVAM), 105 TA patients meeting the 1990 modified American College of Rheumatology (ACR) criteria were registered at the end of July 2017. Total 28 (26,7%) patients were treated with biological therapy and 22 (21.0%) of them were taking tocilizumab. Patients were assessed using a combination of clinical, laboratory and radiological evaluation before and after Tocilizumab therapy. The demographic and clinical characteristics of the patients, the pre-tocilizumab and end of the follow–up acute phase values (Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)), visual analogue scales (VAS) (Pain, Fatigue, Patient Global), and concomitant therapies were recorded. Other clinical, imaging and laboratory results of the TA patients were obtained from hospital files. The comparative imaging (Computed Tomography and Magnetic Resonance Imaging) results of the patients just before the Tocilizumab therapy and during follow-up were recorded from the hospital data system. <h3>Results</h3> Twenty-two patients (86.4% female) were included in to the analysis. The median (minimum-maximum) age of the patients was 40<sup>24–63</sup> years and the median disease duration (from diagnosis) was 48<sup>12–168</sup> months. Before tocilizumab therapy; cyclophosphamide (8 patients (36.4%), conventional immunosuppressives (21 patients, 95.4%) and TNFi (7 patients, 31.8%) were used in addition to corticosteroid therapy. Main indications for tocilizumab therapy was as follows; radiological progression in 9 patients (acute phase was normal in 2 of them), acute phase elevation in 8 patients (4 of them radiologically stable, 4 of them had no radiologic evaluation), physician's decision and clinical symptoms in 3 patients (acute phase normal; 2 of them radiologically stable, one had no radiologic evaluation), in two patients tocilizumab therapy was started out of our centre and data before tocilizumab was not available. Fifteen patients (median follow-up time 15<sup>3–42</sup> months) were evaluated for response to tocilizumab treatment. There was a significant decrease in ESR, CRP, and VAS-patient-global of patients after tocilizumab therapy; median (min-max) ESR (26<sup>5–119</sup> vs. 3 (2–49) mm/s, p=0.02), CRP (39.8 (2.4–149.0) vs. 7.9 (0–92,9) mg/L, p=0,017), VAS-patient-global (50 (0–90) vs. 30 (0–60), p=0,027), respectively. Total of 9 patients had follow–up imaging; 8 of them was radiologically stable and regression was seen in one patient (figure 1). <h3>Table 1</h3> <h3>Conclusions</h3> The use of biological therapies in more than a quarter of TA patients suggests that the role of conventional therapies in TA is limited. Although imaging modalities and acute phase elevations are the main factors in the decision of change in treatment, presence of symptoms and physician opinion are also important. Significant response was obtained with the treatment of tocilizumab. <h3>Disclosure of Interest</h3> None declared