AB0711 Tocilizumab for severe/refractory vascular behÇet's disease. (12th June 2018)

• Record Type: Journal Article
• Authors: Zheng, W.; Ding, Y.; Liu, J.; Shi, J.; Li, C.; Zhao, Y.; Zeng, X.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 1495
• Page End: 1496
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.4152
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Vascular Behçet's Disease (BD) is a common yet severe complication of BD. Despite aggressive conventional therapy, vascular BD remains as one of the leading causes of morbidity of BD. Tocilizumab (TCZ), an IL-6 receptor antagonist, is an emerging biological agents for neurologic BD or ocular BD, however, the efficacy of TCZ for vascular BD is unknown. Objectives: To elucidate the efficacy and safety of TCZ for severe/refractory vascular BD. Methods: We retrospectively analysed the clinical data of vascular BD patients treated with TCZ in our centre between 2014 and 2017. Results: Seven patients (6 males and 1 female) were enrolled, with a mean age and median course of 32.9±9.1 years old and 72 months (range 54 to 138), respectively. Multiple arterial lesions were documented in all patients, including arterial aneurysm (n=5), stenosis (n=4), occlusion (n=3), and multiple venous thrombosis were documented in two patients. Recurrent aneurysms together with graft occlusion or endoleak occurred in two out of 3 aneurysms patients who underwent endovascular stent placements. As for concomitant medical conditions, one patient complicated with hepatitis B infection, and three complicated with latent tuberculosis infection and received anti-tuberculosis prophylaxis. Prior to TCZ therapy, all patients experienced disease progression despite high-dose glucocorticosteroid in combination with multiple immunosuppressants. All patients received TCZ, 8 mg/kg iv every 4 weeks for a median of 7 (range 3 to 15) doses, and baseline medium-to-low dose corticosteroid and immunosuppressants, After a median follow-up of 16 months (range 4 to 29), all patients achieved both clinical and serological improvements. Radiologic improvement of artery stenosis was demonstrated in one patient. The condition of one patient with endoleak after the stent placement remained stable without surgical intervention. No newly-onset arterial lesions or venous thrombosis were observed. The median ESR (18 vs 7 mm/h, p<0.05) and hsCRP level (30.6 vs 2.0 mg/L, p<0.05) were also significantly decreased. Furthermore, corticosteroids dose was tapered from 27.1±6.3 mg to 8.9±1.2 mg (p<0.05), and immunosuppressants were tapered in number and dosage in 3 (42.9%) and 3 patients (42.9%), respectively. No serious adverse event or TB reactivation was observed. Conclusions: TCZ, in combination with corticosteroids and immunosuppressants, was effective and well tolerated in severe/refractory vascular BD, with a favourable steroid- and immunosuppressant-sparing effect. Disclosure of Interest: None declared