Corticosteroid-free treatment of tocilizumab monotherapy for microscopic polyangiitis: a single-arm, single-center, clinical trial.

Abstract

OBJECTIVES:

To assess the efficacy of tocilizumab (TCZ) monotherapy for the remission induction of microscopic polyangiitis (MPA) in a prospective single-arm, single-center, cohort, pilot study.

METHODS:

Eligible patients were aged between 20 and 80 years and were newly diagnosed with MPA according to Watts' classification algorithm. Seven patients received 8 mg/kg of intravenous TCZ fortnightly for the first 2 months (5 courses), and monthly for the next 10 months (10 courses). One year after TCZ monotherapy, the patients were followed-up without any treatment. The protocol did not permit the use corticosteroids or any other immunosuppressants. Complete remission (CR) was defined as the Birmingham Vasculitis Activity Score of 0 at two consecutive visits made at least a month apart.

RESULTS:

CR was achieved in two of six patients (33.3%) at 6 months and three patients (50.0%) at 12 months. Two patients were withdrawn: one because of inefficacy at 6 weeks and the other because of flare at 6 months. One patient voluntarily withdrew after CR at 3 months. Four patients (66.7%) could be kept drug-free after 1 year of TCZ without relapse for 6-15 months at the last visit.

CONCLUSION:

TCZ monotherapy may be an alternative treatment strategy in some patients with MPA.

• Authors: Ryota Sakai, Tsuneo Kondo, Jun Kikuchi, Akiko Shibata, Kentaro Chino, Ayumi Okuyama, Hirofumi Takei, Koichi Amano
• Journal: Modern rheumatology (Mod Rheumatol) Vol. 26 Issue 6 Pg. 900-907 (Nov 2016) ISSN: 1439-7609 [Electronic] England
• PMID: 26934300 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Adrenal Cortex Hormones
• Antibodies, Monoclonal, Humanized
• tocilizumab

Topics

• Adrenal Cortex Hormones (administration & dosage)
• Adult
• Antibodies, Monoclonal, Humanized (administration & dosage, adverse effects, therapeutic use)
• Female
• Humans
• Male
• Microscopic Polyangiitis (drug therapy)
• Middle Aged