Reversal of chronic arterial stenosis with biologic therapy including tocilizumab in Takayasu arteritis

Abstract Biologic agents have demonstrated efficacy in the treatment of refractory Takayasu arteritis (TAK). Although vascular stenosis is a common manifestation in the chronic phase of TAK, evidence on the effects of biologic therapy on established vascular lesions remains limited. Here, we report case series of TAK in which chronic arterial stenosis showed marked improvement following treatment with biologic agents. The first case was a 27-year-old woman with stenosis of the left common carotid artery. Initial treatment with prednisolone (PSL) led to clinical improvement; however, the vascular lesion progressed during tapering, despite normalization of inflammatory markers. Re-induction with methylprednisolone pulse and methotrexate (MTX) led to slight improvement. Subsequent therapy with tocilizumab (TCZ), followed by golimumab (GLM), resulted in significant and sustained improvement in the stenosis. The second case was a 20-year-old woman with wall thickening of the right brachiocephalic artery. Although PSL and MTX were initially administered, progression of left subclavian artery stenosis was detected on ultrasonography before symptom onset, despite normalized inflammatory markers. Introduction of TCZ with increased PSL led to notable improvement in the vascular lesions. These cases and literature review suggest that biologic agents may reverse vascular remodeling in chronic TAK, even in the absence of systemic inflammatory activity. Comprehensive disease assessment using imaging modalities, alongside serum biomarkers, is essential to guide therapeutic decisions and monitor vascular changes. These findings highlight the importance of imaging-based disease monitoring and raise the potential for targeted treatment strategies aimed at both inflammation control and vascular lesion modification.