Utility and safety of tocilizumab in Takayasu arteritis with severe heart failure and muscle wasting

• Main Authors: Toshiyuki Yano, Arata Osanami, Masaki Shimizu, Satoshi Katano, Nobutaka Nagano, Hidemichi Kouzu, Masayuki Koyama, Atsuko Muranaka, Ryo Harada, Hirosato Doi, Nobuyoshi Kawaharada, Tetsuji Miura
• Format: Article
• Language: English
• Published: Wiley 2019-08-01
• Series: ESC Heart Failure
• Subjects: Takayasu arteritis; Tocilizumab; Interleukin‐6; Heart failure; Aortic regurgitation; Sarcopenia
• Online Access: https://doi.org/10.1002/ehf2.12487

Abstract Takayasu arteritis (TA) is a large vessel vasculitis of unknown aetiology characterized by chronic inflammatory changes of the aorta and its major branches. We report the active TA case who had severe heart failure due to acute myocardial infarction and aortic regurgitation. Bentall procedure was successfully performed, but he had severely depressed left ventricular function and muscle wasting together with vascular inflammation. The treatment with tocilizumab, an interleukin‐6 receptor monoclonal antibody, in addition to prednisolone and standard heart failure therapy led to prompt remission of TA activity and improvement of left ventricular function and muscle wasting. Taken together with possible involvement of interleukin‐6 in the pathogenesis of heart failure and muscle wasting, inhibition of interleukin‐6 receptor signalling by tocilizumab may be a safe and reasonable approach in the treatment of active TA with heart failure and muscle wasting.