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Vasculitis
Clinical case
Treatment of polyarteritis nodosa with tocilizumab: a new therapeutic approach?
  1. Aurélie Saunier1,
  2. Nahéma Issa1,
  3. Marie-Anne Vandenhende1,
  4. Philippe Morlat1,
  5. Marie-Sylvie Doutre2 and
  6. Fabrice Bonnet1
  1. 1 Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
  2. 2 Service de Dermatologie, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
  1. Correspondence to Dr Fabrice Bonnet; fabrice.bonnet{at}chu-bordeaux.fr

Abstract

We describe the effect of interleukin 6 (IL-6) blockade using tocilizumab (TCZ) for inducing and maintaining remission of refractory polyarteritis nodosa (PAN). Three patients with refractory PAN defined according to the American College of Rheumatology criteria were treated with TCZ infusions (8 mg/kg) on a monthly basis. All of them had severe cutaneous and articular involvement with elevated biological inflammatory markers. One suffered from a neuritis multiplex and one from renal and digestive damage. All three patients were dependent on high doses of glucocorticoids (above 0.5 mg/kg) and two of them were resistant to immunosuppressive drugs. All patients achieved and maintained clinical response and normalisation of the inflammation acute-phase proteins after a few weeks of treatment with TCZ. Prednisolone could be reduced by an average of 41–13 mg/day. These first case reports suggest that IL-6 blockade using TCZ could be a therapeutic alternative to induce remission in patients with polyarteritis nodosa resistant or intolerant to the reference treatment.

  • polyarteritis nodosa
  • tocilizumab
  • treatment

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2017-000446

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    Footnotes

    • Contributors All authors have participated to the management of these patients, to the collection of the data and to the analyses of the results. All authors have approved the manuscript before submission.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data can be obtained from the corresponding author.