EFFICACY AND SAFETY OF TNF-α ANTAGONISTS AND TOCILIZUMAB IN TAKAYASU ARTERITIS: MULTICENTER WORLDWIDE RETROSPECTIVE STUDY OF 209 PATIENTS
Authors: A. Mekinian et al.
The revised EULAR guidelines for the Management of Large Vessel Vasculites (2018) state that tocilizumab (TCZ) and infliximab are equivalent therapeutic options in Takayasu Arteritis (TAK). Probably, based on the excellent efficacy of TCZ, but the lack of efficacy of TNF-antagonists in Giant Cell Arteritis, physicians are biased towards TCZ in the treatment of TAK.
In a large worldwide TAK registry, 209 patients were either treated with TNF-α antagonists or with TCZ, allowing assessment of safety and efficacy as well as predictive factors of treatment response and relapse. Median age of patients was 29 years [7-62], 186 (89%) were females. 132 (63%) received TNF-α antagonists (infliximab (n=109), adalimumab (n=45), golimumab (n=8), certolizumab (n=6) and etanercept (n=5), 77 (37%) received TCZ. A complete response at 6 months was evidenced in 101/152 (66%) on TNF-α antagonists and 75/107 (70%) on TCZ, respectively. Age ≥ 30 years was associated with complete response, whereas vascular signs, baseline prednisone ≥ 20 mg/day were negatively associated with the complete response to TNF-α antagonists or TCZ. During a median follow-up of 36 months, 103 relapses were noted. Supra-aortic branches and thoracic aorta involvement as well as systemic signs at baseline were significantly associated with relapse. The cumulative incidence of treatment discontinuation and relapse were similar in TNFα antagonists and TCZ. Fifty-eight (20%) adverse effects occurred on biological-targeted therapies of whom 37 (21%) and 21 (17%), (p=0.4) on TNF-α antagonists and TCZ, respectively.
The data confirm a comparable efficacy and safety of the two treatment strategies. The equivalent performance of TNF-antagonists is of particular interest in pregnancy planning as TAK predominantly affects young females. Finally, the data underline the fact that pathogenesis of GCA and TAK are similar but not the same.