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      Resultados a largo plazo de tocilizumab para el tratamiento de arteritis de Takayasu en la práctica clínica Translated title: Long-term results of tocilizumab for the treatment of Takayasu arteritis in clinical practice

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          Abstract

          Resumen La arteritis de Takayasu (AT) es una enfermedad rara descrita como una vasculitis granulomatosa que afecta a las arterias elásticas de gran calibre, fundamentalmente la aorta y sus ramas principales. Como consecuencia de la inflamación de estos grandes vasos, puede dar lugar a la formación de aneurismas, estenosis u oclusión vascular. Afecta principalmente a mujeres jóvenes y los síntomas incluyen: síncope, mareo, disminución o ausencia de pulso, y alteración de la visión. El tratamiento convencional se basa principalmente en la utilización de corticoides e inmunosupresores, aunque recientemente se ha comenzado a considerar el uso de fármacos biológicos. Tocilizumab es un anticuerpo monoclonal dirigido contra IL-6 utilizado fuera de ficha técnica en algunos pacientes para tratar esta patología. Presentamos dos casos clínicos que describen el uso a largo plazo de tocilizumab en pacientes con AT refractaria al tratamiento convencional. En ambos casos se observó una excelente respuesta a tocilizumab, con remisión de la sintomatología y reducción de las dosis de corticoides asociados. No se registraron eventos adversos asociados al tratamiento.

          Translated abstract

          Summary Takayasu arteritis (TA) is a rare disease described as a granulomatous vasculitis that affects large-caliber elastic arteries, mainly the aorta and its main branches. As consequence of inflammation of these great vessels, TA can lead to the formation of aneurysms, stenosis or vascular occlusion. This pathology mainly affects young women and symptoms include: syncope, dizziness, decreased or absent pulse, and visual impairments. Conventional treatment is mainly based on the use of corticosteroids and immunosuppressants, although biological drugs has recently begun to be considered. Tocilizumab is a monoclonal antibody directed against IL-6 used off-label in some patients to treat this pathology. We present two clinical cases describing the long-term use of tocilizumab in patients with TA refractory to conventional treatment. In both cases, an excellent response to tocilizumab with remission of symptoms and a reduction in associated corticosteroid doses was observed. No adverse events associated with treatment were collected.

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          Most cited references10

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          Takayasu arteritis: an update.

          Takayasu arteritis has long been considered as an uncommon disease, rather specific to the Far-East; however recent surveys show that the disease can be seen in all ethnicities around the world with increasing prevalence rates. Nowadays, it would not be fair to consider Takayasu arteritis as a rare disease.
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            Recent advances in the management of Takayasu arteritis.

            Takayasu arteritis (TA) is a challenging large vessel vasculitis to treat. Distinguishing disease activity from vascular damage is difficult, often relying on clinician judgement aided by composite clinical disease activity indices with angiographic evidence of vessel wall thickening or vessel wall hypermetabolism demonstrable on positron emission tomography computerized tomography (PET CT). Glucocorticoids form the mainstay of remission induction. While other conventional disease modifying anti-rheumatic drugs (cDMARDs) or biologic DMARDs (bDMARDs) are commonly used, evidence supporting their usefulness is sparse and generally of low quality. The only two randomized controlled trials (RCT) of a DMARD in TA failed to show efficacy of abatacept in reducing relapses of TA, however, tocilizumab showed a trend towards reduction in time to relapses. Of the cDMARDs, methotrexate, azathioprine, mycophenolate mofetil (MMF), leflunomide and cyclophosphamide have shown clinical efficacy in case series, with some evidence that methotrexate, azathioprine and MMF might retard angiographic progression. Among bDMARDs, anti-tumor necrosis factor alpha agents and tocilizumab may be useful in patients refractory to cDMARDs with retardation of angiographic progression, based on evidence derived from mostly retrospective case series, whereas the role of rituximab and ustekinumab needs further elucidation. Revascularization, either surgical or endovascular, is the treatment of choice to relieve critical, symptomatic stenoses and are best undertaken during inactive disease. Emerging evidence suggests that patients with TA also have increased cardiovascular risk and this requires appropriate management. Large studies involving multiple centers are the need of the hour to appropriately evaluate utility of currently available immunosuppressive therapy in TA.
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              Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

              Objective To collect available evidence on management of large vessel vasculitis to inform the 2018 update of the EULAR management recommendations. Methods Two independent systematic literature reviews were performed, one on diagnosis and monitoring and the other on drugs and surgical treatments. Using a predefined PICO (population, intervention, comparator and outcome) strategy, Medline, Embase and Cochrane databases were accessed. Eligible papers were reviewed and results condensed into a summary of findings table. This paper reports the main results for Takayasu arteritis (TAK). Results A total of 287 articles were selected. Relevant heterogeneity precluded meta-analysis. Males appear to have more complications than females. The presence of major complications, older age, a progressive disease course and a weaker inflammatory response are associated with a more unfavourable prognosis. Evidence for details on the best disease monitoring scheme was not found. High-quality evidence to guide the treatment of TAK was not found. Glucocorticoids are widely accepted as first-line treatment. Conventional immunosuppressive drugs and tumour necrosis factor inhibitors were beneficial in case series and uncontrolled studies. Tocilizumab failed the primary endpoint (time to relapse) in a randomised controlled clinical trial; however, results still favoured tocilizumab over placebo. Vascular procedures may be required, and outcome is better when performed during inactive disease. Conclusions Evidence to guide monitoring and treatment of patients with TAK is predominantly derived from observational studies with low level of evidence. Therefore, higher-quality studies are needed in the future.
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                Author and article information

                Journal
                ofil
                Revista de la OFIL
                Rev. OFIL·ILAPHAR
                Organización de Farmacéuticos Ibero-Latinoamericanos (Madrid, Madrid, Spain )
                1131-9429
                1699-714X
                March 2022
                : 32
                : 1
                : 105-106
                Affiliations
                [1] Toledo Talavera de la Reina orgnameHospital General Nuestra Señora del Prado orgdiv1Servicio de Farmacia España
                [2] Las Palmas Arrecife orgnameHospital Doctor José Molina Orosa orgdiv1Servicio de Farmacia España
                Article
                S1699-714X2022000100021 S1699-714X(22)03200100021
                10.4321/s1699-714x20220001000021
                490e6ecb-2ee0-47ac-8704-b7d1cca3db67

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 06 November 2020
                : 25 November 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 2
                Product

                SciELO Spain

                Categories
                Casos Clínicos

                Arteritis de Takayasu,Takayasu arteritis,vasculitis,tocilizumab,corticoids,corticoides

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