Comparative Effectiveness of Tocilizumab and Tumor Necrosis Factor Inhibitors in Takayasu Arteritis: Age-Related Differences in Treatment Response
In brief
TNF blockers and tocilizumab had similar response rates in Takayasu arteritis
In 151 patients, 72.1% responded to tumor necrosis factor inhibitors and 60.7% to tocilizumab, with no significant difference between treatments. Response patterns differed by age at disease onset, and 94% of patients responded after switching treatment following failure, but the findings do not establish which drug works best for an individual patient.
- Journal
- Arthritis care & research (Q1)
- Published
- 28 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Sreenidhi Sankararaman, Alessandro Tomelleri, Corrado Campochiaro, Luciana Yamamoto de Almeida, Chiara Bellino, Elena Baldissera, et al.
- PMID
- 42803195
- DOI
- 10.1002/acr.80169
Why clinicians should know about it
- Picked for Rheumatology (paper of the day, 30 September 2026): Comparative effectiveness of TCZ vs TNFi in Takayasu arteritis
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.