Comparative Effectiveness of Tocilizumab and Tumor Necrosis Factor Inhibitors in Takayasu Arteritis: Age‐Related Differences in Treatment Response

Objective

Comparative, prospective data on biologics for Takayasu arteritis (TAK) are limited. We compared tumor necrosis factor inhibitors (TNFi) and tocilizumab (TCZ) in a combined cohort, assessed demographic and cytokine influences, and evaluated longitudinal outcomes.

Methods

Clinical response to TNFi or TCZ was assessed in patients with TAK from two independent cohorts. In a subset followed prospectively within a standardized research protocol, physician global assessment (PGA), C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), and FDG‐PET activity were compared pre‐ and post‐treatment. Time to response was analyzed using Kaplan–Meier curves. Cytokine levels were measured with Luminex assays in patients and age‐matched healthy controls.

Results

Among 151 patients (Cohort A=57; Cohort B=94), 129 received TNFi and 56 received TCZ during follow‐up. Clinical response rates were 72.1% for TNFi and 60.7% for TCZ (p = 0.17). In the prospective subset, no significant differences in PGA, CRP, ESR, or FDG‐PET outcomes (p > 0.30) were observed. Changing to another TNFi or switching between TNFi or TCZ after treatment failure resulted in clinical response in 31/33 (94%) patients. TNFi responders had younger median age at onset than non‐responders (23 vs 33.5 years, p = 0.0039), whereas TCZ responders were older (35 vs 21.5 years, p = 0.0043). Patients with onset <30 years showed elevated IL‐6 and TNF versus controls, a pattern not observed in older patients.

Conclusion

TNFi and TCZ demonstrate similar effectiveness in TAK. These findings support therapeutic switching after treatment failure and suggest that age‐related immunologic differences may influence treatment response.

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