Tocilizumab for severe refractory primary central nervous system vasculitis: A center experience

Autores da FMUP

• Joana Da Cruz Guimarães Ferreira De Almeida

  Autor

• Pedro Miguel Paredes De Abreu

  Autor

• Elsa Irene Peixoto Azevedo Silva

  Autor

Participantes de fora da FMUP

• Cabreira, V
• Dias, L
• Fernandes, B
• Aires, A

Unidades de investigação

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Neurociências Clínicas e Saúde Mental

Abstract

Background: Primary Central Nervous System Vasculitis (PCNSV) is responsible for 3%-5% of strokes before age 50. It presents with clinical, radiological, and pathological variability. Optimal management is unknown given the absence of randomized clinical trials. Aims of the study: Explore whether tocilizumab, an anti-interleukin-6 monoclonal antibody, is an effective treatment for refractory PCNSV. Methods: Patients with PCNSV treated with tocilizumab in a single tertiary center were reviewed. Results; Three patients were identified. In two of them, MRI-revealed ischemic lesions. The other presented with a subcortical hemispheric pseudotumoral lesion. Brain biopsy was inconclusive in two patients. Due to a significant number of relapses and clinical deterioration despite other immunosuppressive drugs, tocilizumab was initiated and induced a long remission period up to 44 months. Observed side effects were a fungic infection, neutropenia and thrombocytopenia (both transitory), and a pulmonary embolism in one of the cases. Conclusions: Tocilizumab might be a therapeutic option for PCNSV (Class IV evidence), given its efficacy and safety. We propose a novel pathway for diagnosis and therapeutics of PCNSV with the purpose of improving the diagnosis, monitoring, and prognosis of this heterogeneous disorder, setting the framework for future use of tocilizumab in this condition.

Keywords

• central nervous system angeitis; cerebrovascular disorders; CNS vasculitis; monoclonal antibodies; tocilizumab