Use of biologics to treat relapsing and/or refractory polyarteritis nodosa: data from a European collaborative study
Jérôme Hadjadj, Alice Canzian, Ömer Karadağ, A. Contis, F. Maurier, Sébastien Sanges, Silvia Sartorelli, Laure Denis, Claire de Moreuil, Cécile‐Audrey Durel, S. Durupt, M. Jachiet, D. Rouzaud, Carlo Salvarani, Roberto Padoan, Lorenzo Dagna, Fabrice Bonnet, C. Agard, T. Moulinet, M. Hermet, R. Sterpu, A. Maria, Jérémy Keraen, Loı̈c Guillevin, David Jayne, Benjamin Terrier
Abstract
OBJECTIVES: To describe the effectiveness and safety of biologics for the treatment of relapsing and/or refractory polyarteritis nodosa (PAN). METHODS: A retrospective European collaborative study was conducted in patients with PAN who received biologics for relapsing and/or refractory disease. RESULTS: Forty-two patients with PAN received a total of 53 biologic courses, including TNF-α blockers in 15 cases, rituximab (RTX) in 18 cases, tocilizumab (TCZ) in 10 cases and other biologics in 10 cases. TNF-α blockers and TCZ were mainly used for refractory diseases whereas RTX was mainly initiated for relapsing disease. After a median follow-up of 29 (8-50) months, remission, partial response, treatment failure and treatment discontinuation due to severe adverse events occurred in, respectively, 40%, 13%, 40% and 7% of patients receiving TNF-α blockers, 50%, none, 30% and 20% of TCZ recipients, and 33%, 11%, 56% and none of the RTX recipients. No remission was noted in patients treated with other biologics. Severe adverse events were observed in 14 (28%) patients without significant differences between the three biologics, leading to early biologics discontinuation in only three cases. CONCLUSION: These results suggest that TCZ may be effective in relapsing and/or refractory PAN. Our data warrant further study to confirm these findings.