Tocilizumab for severe refractory neuro-Behçet: Three cases IL-6 blockade in neuro-Behçet

Olga Addimanda, Nicolò Pipitone, Giulia Pazzola, Carlo Salvarani

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Objectives: To describe the response to IL-6 blockade [tocilizumab (TCZ)] in three patients affected by highly refractory neuro-Behçet disease (NBD). Methods: Three patients who had failed synthetic immunosuppressants and TNF-α antagonists combined with glucocorticoids received TCZ after obtaining their informed consent. Two patients underwent TCZ infusions at 8. mg/kg every 4 weeks for a mean period of 24 months, while in one patient, the frequency of TCZ infusions was increased to every other week after 21 months due to a disease flare. Concomitant therapy with synthetic agents and low-to-medium dose glucocorticoids was continued. Clinical and imaging findings were assessed before and after the onset of TCZ therapy. Results: In all our patients, a very short time lag between the onset of treatment with TCZ and the clinical response was observed. A partial response occurred in two patients and a nearly complete response in one. Some loss of efficacy occurred after 18 months in one patient, but there was again a significant improvement when the interval between the infusions was shortened. TCZ was overall well tolerated and no serious adverse events occurred. In two patients, the prednisone dose could successfully be tapered to about 20. mg/day, while in another patient glucocorticoids could safely be withdrawn. Brain MRI remained virtually unchanged in all patients. Conclusions: Although TCZ has not yet been included among the medications recommended for the treatment of NBD, our data suggest that it may be considered for patients with refractory NBD.

Original languageEnglish
Pages (from-to)472-475
Number of pages4
JournalSeminars in Arthritis and Rheumatism
Volume44
Issue number4
DOIs
Publication statusPublished - 2015

Fingerprint

Interleukin-6
Glucocorticoids
tocilizumab
Therapeutics
Immunosuppressive Agents
Prednisone
Informed Consent
Brain

Keywords

  • Anti-TNF-alfa agents
  • Biologic therapies
  • Corticosteroids
  • IL-6
  • IL-6 blockade
  • Neuro-Behçet
  • Refractory disease

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

Tocilizumab for severe refractory neuro-Behçet : Three cases IL-6 blockade in neuro-Behçet. / Addimanda, Olga; Pipitone, Nicolò; Pazzola, Giulia; Salvarani, Carlo.

In: Seminars in Arthritis and Rheumatism, Vol. 44, No. 4, 2015, p. 472-475.

Research output: Contribution to journalArticle

@article{f8dad5dba051433fafac6e41072a0c1a,
title = "Tocilizumab for severe refractory neuro-Beh{\cc}et: Three cases IL-6 blockade in neuro-Beh{\cc}et",
abstract = "Objectives: To describe the response to IL-6 blockade [tocilizumab (TCZ)] in three patients affected by highly refractory neuro-Beh{\cc}et disease (NBD). Methods: Three patients who had failed synthetic immunosuppressants and TNF-α antagonists combined with glucocorticoids received TCZ after obtaining their informed consent. Two patients underwent TCZ infusions at 8. mg/kg every 4 weeks for a mean period of 24 months, while in one patient, the frequency of TCZ infusions was increased to every other week after 21 months due to a disease flare. Concomitant therapy with synthetic agents and low-to-medium dose glucocorticoids was continued. Clinical and imaging findings were assessed before and after the onset of TCZ therapy. Results: In all our patients, a very short time lag between the onset of treatment with TCZ and the clinical response was observed. A partial response occurred in two patients and a nearly complete response in one. Some loss of efficacy occurred after 18 months in one patient, but there was again a significant improvement when the interval between the infusions was shortened. TCZ was overall well tolerated and no serious adverse events occurred. In two patients, the prednisone dose could successfully be tapered to about 20. mg/day, while in another patient glucocorticoids could safely be withdrawn. Brain MRI remained virtually unchanged in all patients. Conclusions: Although TCZ has not yet been included among the medications recommended for the treatment of NBD, our data suggest that it may be considered for patients with refractory NBD.",
keywords = "Anti-TNF-alfa agents, Biologic therapies, Corticosteroids, IL-6, IL-6 blockade, Neuro-Beh{\cc}et, Refractory disease",
author = "Olga Addimanda and Nicol{\`o} Pipitone and Giulia Pazzola and Carlo Salvarani",
year = "2015",
doi = "10.1016/j.semarthrit.2014.08.004",
language = "English",
volume = "44",
pages = "472--475",
journal = "Seminars in Arthritis and Rheumatism",
issn = "0049-0172",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - Tocilizumab for severe refractory neuro-Behçet

T2 - Three cases IL-6 blockade in neuro-Behçet

AU - Addimanda, Olga

AU - Pipitone, Nicolò

AU - Pazzola, Giulia

AU - Salvarani, Carlo

PY - 2015

Y1 - 2015

N2 - Objectives: To describe the response to IL-6 blockade [tocilizumab (TCZ)] in three patients affected by highly refractory neuro-Behçet disease (NBD). Methods: Three patients who had failed synthetic immunosuppressants and TNF-α antagonists combined with glucocorticoids received TCZ after obtaining their informed consent. Two patients underwent TCZ infusions at 8. mg/kg every 4 weeks for a mean period of 24 months, while in one patient, the frequency of TCZ infusions was increased to every other week after 21 months due to a disease flare. Concomitant therapy with synthetic agents and low-to-medium dose glucocorticoids was continued. Clinical and imaging findings were assessed before and after the onset of TCZ therapy. Results: In all our patients, a very short time lag between the onset of treatment with TCZ and the clinical response was observed. A partial response occurred in two patients and a nearly complete response in one. Some loss of efficacy occurred after 18 months in one patient, but there was again a significant improvement when the interval between the infusions was shortened. TCZ was overall well tolerated and no serious adverse events occurred. In two patients, the prednisone dose could successfully be tapered to about 20. mg/day, while in another patient glucocorticoids could safely be withdrawn. Brain MRI remained virtually unchanged in all patients. Conclusions: Although TCZ has not yet been included among the medications recommended for the treatment of NBD, our data suggest that it may be considered for patients with refractory NBD.

AB - Objectives: To describe the response to IL-6 blockade [tocilizumab (TCZ)] in three patients affected by highly refractory neuro-Behçet disease (NBD). Methods: Three patients who had failed synthetic immunosuppressants and TNF-α antagonists combined with glucocorticoids received TCZ after obtaining their informed consent. Two patients underwent TCZ infusions at 8. mg/kg every 4 weeks for a mean period of 24 months, while in one patient, the frequency of TCZ infusions was increased to every other week after 21 months due to a disease flare. Concomitant therapy with synthetic agents and low-to-medium dose glucocorticoids was continued. Clinical and imaging findings were assessed before and after the onset of TCZ therapy. Results: In all our patients, a very short time lag between the onset of treatment with TCZ and the clinical response was observed. A partial response occurred in two patients and a nearly complete response in one. Some loss of efficacy occurred after 18 months in one patient, but there was again a significant improvement when the interval between the infusions was shortened. TCZ was overall well tolerated and no serious adverse events occurred. In two patients, the prednisone dose could successfully be tapered to about 20. mg/day, while in another patient glucocorticoids could safely be withdrawn. Brain MRI remained virtually unchanged in all patients. Conclusions: Although TCZ has not yet been included among the medications recommended for the treatment of NBD, our data suggest that it may be considered for patients with refractory NBD.

KW - Anti-TNF-alfa agents

KW - Biologic therapies

KW - Corticosteroids

KW - IL-6

KW - IL-6 blockade

KW - Neuro-Behçet

KW - Refractory disease

UR - http://www.scopus.com/inward/record.url?scp=84927605289&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84927605289&partnerID=8YFLogxK

U2 - 10.1016/j.semarthrit.2014.08.004

DO - 10.1016/j.semarthrit.2014.08.004

M3 - Article

C2 - 25260843

AN - SCOPUS:84927605289

VL - 44

SP - 472

EP - 475

JO - Seminars in Arthritis and Rheumatism

JF - Seminars in Arthritis and Rheumatism

SN - 0049-0172

IS - 4

ER -