Comparison of drug retention rates between TNF inhibitors and tocilizumab for Takayasu arteritis: a multicenter retrospective study

Objective. We compared the drug retention rate of tumor necrosis factor (TNF) inhibitors (TNFi) and tocilizumab in Takayasu arteritis (TAK) as an index of balance between effectiveness and safety in a real-world setting. Method. We included 50 TAK patients who received biologics in nine hospitals. All patients fulfilled the 1990 American College of Rheumatology classification criteria for TAK. We retrospectively collected clinical information. We analyzed the drug retention rates and the reasons for discontinuation regarding TNFi and tocilizumab. Results. The prednisolone dose at the start of the first biologics was a median of 15 mg/day, and an immunosuppressant was used in 25 patients. Tocilizumab was the most frequent first biologics (64%). Twenty-seven of 32 patients continued on tocilizumab, and four of 18 patients continued on TNFi. The retention rate was significantly higher in tocilizumab than in TNFi (87.9% vs. 66.7% at one year, p = 0.024). The reasons for discontinuing tocilizumab were primary failure in two patients, and other reasons in three. The reasons for discontinuing TNFi were secondary failure in five patients, primary failure in four patients, and other reasons in five. Conclusion. Tocilizumab has a higher continuation rate than TNFi, suggesting that tocilizumab may have better benefit-risk balance for TAK patients.