Takayasu Treatment — SCE Rheumatology MCQ

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HardVasculitisTakayasu TreatmentSCE Rheumatology

A 42-year-old woman with Takayasu arteritis is being treated with Prednisolone and Methotrexate. Despite treatment she has progressive aortic arch disease. Which biologic has the strongest evidence in refractory Takayasu arteritis?

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Correct answer: C — Tocilizumab

Tocilizumab (IL-6 receptor inhibitor) has the strongest evidence for refractory Takayasu arteritis. Several case series and a randomised trial have demonstrated efficacy in maintaining remission and enabling steroid tapering. TNF inhibitors are also used but Tocilizumab is increasingly favoured. EULAR large vessel vasculitis recommendations support biologic therapy for refractory cases. IL-6 is a key cytokine in Takayasu arteritis pathogenesis making IL-6 blockade a rational targeted approach. CRP monitoring limitations on Tocilizumab apply as in GCA.

Reference: EULAR 2018 large vessel vasculitis recommendations; Nakaoka Y et al 2013 Tocilizumab in Takayasu