Efficacy and tolerance of infliximab in refractory Takayasu arteritis: French multicentre study

Objective. To analyse the efficacy and tolerance of infliximab in refractory Takayasu arteritis (TA). Methods. French multicentre retrospective study that included patients with TA. Clinical disease activity was defined as new vascular and/or constitutional signs. Results. Fifteen patients with TA [median age 41 (range 1761) years; 13 women] were included. At initiation of infliximab therapy, 14 patients were treated with CSs [prednisone; median dose 20 (range 535) mg/day], MTX (n = 7) or AZA (n = 4). Infliximab was used at median 5 (range 35) mg/kg at a median of every 6 (range 48) weeks. A partial or good overall response was noted in 13 (87%) of the 15 cases, 10 (77%) of the 13 cases and 8 (73%) of the 11 cases at 3, 6 and 12 months, respectively. Clinical and biological activities significantly decreased within 3 months (from 11 at baseline to 4 patients at 12 months; P < 0.05), and similarly for CS dose [from median 20 (range 535) mg/day at baseline to median 6 (range 2.530) mg/day at 12 months; P < 0.05]. Only one patient was still steroid-dependent at 12 months (vs 8 cases before infliximab). CRP regressed from a median 30 (range 470) mg/l to 5 (range 057) mg/l and 6( 050) mg/l at 3 and 6 months, respectively (P < 0.05). Side effects were two infusion-related reactions, one pulmonary tuberculosis, one severe bacterial infection and EBV reactivation. Conclusion. This study confirms the interest of infliximab in terms of clinical and biological response, as well as the steroid-sparing effect in TA.