Our Experience with The Use of Interleukin 6 Inhibitor - Tocilizumab, In the Complex Treatment of Nonspecific Aortoarteritis

Аннотация

The need for further improvement of treatments for Takayasu's arteritis (TA), the progress in understanding the mechanisms of the disease, and the introduction of biological agents (BA) in rheumatology practice have created preconditions for developing a new TA pharmacotherapy using BA associated with interleukin 6 (IL-6) inhibition. The authors describe their two own cases of tocilizumab (TCZ) use for complicated TA. In one case with a long history of complicated TA and glucocorticosteroid intolerance, the use of TCZ contributed to the control of disease activity. In the other case with the onset of TA and focal pulmonary tuberculosis (TB) treated with anti-TB drugs during TCZ monotherapy for 6 months could control TA and achieve TB cure. The use of IL-6 inhibitors should be considered as a potentially effective and relatively safe innovative (off-label) treatment for refractory TA in patients with intolerance or contraindications to standard therapy, which requires further larger randomized clinical trials. Keywords: Nonspecific aortoarteritis ; Takayasu's arteritis; interleukin 6; tocilizumab. HLA class II disease, in contrast to giant cell arteritis Introduction: Takayasu arteritis ( TA ) or nonspecific (GCA), another form of large-vessel TB that is aortoarteritis is systemic in the group of vasculitis ( TV associated with HLA class I. [2-4]. Antibodies have been ) . disease big, big of the veins damage with is shown to be associated with HLA-Bw52 and HLA-B39 described, usually from the age of 50 small in patients [3, 5], and patients with the HLA-B39 allele have been develops and a medium and his/her main networks shown to respond poorly to standard Arteritis, often granulomatous, superior contamination immunosuppressive therapy and require the use of with is described. [1]. GABA (genetically engineered biological drugs) [6]. The etiology of TA is unknown, the influence of genetic The rarity of TA, the variability of the lesion sites [7], factors is more discussed, and TA is considered a typical International Journal of Medical Sciences And Clinical Research 10 https://theusajournals.com/index.php/ijmscr International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265) and the lack of standard reliable instrumental or related to receptors, but to IL-6 was. laboratory markers of activity [8] explain the lack of Since 2008 [22], tocilizumab (T Ts Z), IgG 1 randomized controlled trials on TA until recently. immunoglobulin lower from class human IL-6 receptor According to the results of retrospective observational for recombinant humanized monoclonal antibodies, studies, standard treatment with glucocorticoids (GCs) soluble and selectively with membrane IL-6 receptors and cytostatics, primarily methotrexate (MT) [9] may binds, suppresses classical and trans-signaling IL. 6 not be sufficient to achieve complete stable remission receptor pathways 6 individual cases of TA, especially of TA. Thus, D. Freitas et al. [10] During treatment with to standard therapy durable or to him against to the GCs and MT, the progression of the disease is detected instructions owner those who were in treatment in 75% of cases with new localization of vascular successful is used. Recently small Japanese couple damage during instrumental examination. According to randomized, placebo- controlled, phase III test (RP C T) various authors, relapses develop in 22-72% of patients first The results are presented in [23]. They are with TA with a decrease in the dose of GCs [11-13]. In refractory TA remission save stay for T Ts Z security and turn, the complications of GCS therapy can compete efficiency studied. with the complications of the underlying disease. In METHODS addition, the use of GCS in patients with renal artery disease is limited due to the increased risk of secondary We are G K C and from cytostatics limited complicated hypertension. to use Using T Ts Z in TA according to two own our observations present We will. In patients with clinically hemodynamically significant circulatory disorders, surgical treatment is used, i.e., Patient M. From the age of 13, repeated erythema angioplasty or stenting is used for high-grade arterial nodules and arthralgias appearance sick since. from stenosis; in stenosis accompanied by severe periarterial 2017 from up to 39°С fever added, blood pressure (AQB fibrosis or occlusive stenosis, bypass and other ) 200/100 mm .sim .ust. rose to B soup pain , up to 7 reconstructive procedures are performed. Surgical times a day unconscious to leave , to leave of the hand procedures are never performed in the active phase of inactivity was observed . 2017 in September of the year TA. However, during routine examinations, the activity first pregnancy during inspection on time Doppler to of the disease may not be evident, segmental ultrasound ( ultrasound ) data according to general inflammation of the blood vessel wall sometimes sleep artery stenosis is determined up to 70% . proceeds su