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Peer-reviewedCC BY-NC-ND 4.0In Vivo

Sustained Tocilizumab and Adjunctive HydroBox Therapy in Refractory Takayasu Arteritis: An 11-year Case Report

  • CHEN-YU LIAO1
  • JENG-WEI LU2,3,4
  • YI-JUNG HO5,6
  • SHAN-WEN LUI7
  • TING-YU HSIEH8
  • WUN-LONG JHENG9,10
  • FENG-CHENG LIU11
11 affiliations
  1. 1School of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C.
  2. 2Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung, Taiwan, R.O.C.
  3. 3Biotech Research and Innovation Centre, University of Copenhagen, Copenhagen, Denmark
  4. 4The Finsen Laboratory, Rigshospitalet/National University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  5. 5School of Pharmacy, National Defense Medical University, Taipei, Taiwan, R.O.C.
  6. 6Graduate Institute of Life Sciences, National Defense Medical University, Taipei, Taiwan, R.O.C.
  7. 7Department of Internal Medicine, Linkou Chang-Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C.
  8. 8Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.
  9. 9Cancer Center, Hualien Tzu-Chi Hospital, Hualien, Taiwan, R.O.C.
  10. 10Department of Engineering Medicine, Shizuoka Center for Molecular Intelligence, Hamamatsu, Japan
  11. 11Rheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan, R.O.C.
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Abstract

Background/Aim: Takayasu arteritis (TAK) is a rare, chronic granulomatous large-vessel vasculitis predominantly affecting young women, characterized by progressive stenosis and occlusion of the aorta and its major branches. Despite advances in biologic therapy, refractory disease with recurrent vascular complications remains a significant clinical challenge. Molecular hydrogen-based adjuvant (HydroBox) therapy has emerged as a promising adjuvant approach owing to its antioxidant and immunomodulatory properties. This report aims to describe the long-term clinical course and therapeutic outcomes of a patient with refractory TAK managed with sustained tocilizumab and HydroBox-assisted immunomodulatory therapy over 11 years.

Case Report: We report the case of a 25-year-old female with refractory TAK first diagnosed at age 13, presenting with sudden vision loss, dizziness, and pulseless upper extremities. Disease course was complicated by extensive great-vessel involvement, multiple cerebral infarctions, and recurrent in-stent restenosis despite ongoing interleukin-6 (IL-6) blockade. Over 50 courses of tocilizumab (Actemra) were administered from 2014 onward, combined with multiple percutaneous transluminal angioplasty and stenting procedures. HydroBox-assisted immunomodulatory therapy was subsequently introduced as an adjunctive treatment. During continued follow-up, the patient remained clinically stable with sustained suppression of inflammatory markers and favorable cerebrovascular findings on serial imaging.

Conclusion: This 11-year case report documents the feasibility of sustained long-term tocilizumab therapy combined with adjunctive HydroBox therapy in a patient with refractory TAK. Despite extensive multi-vessel involvement, recurrent in-stent restenosis, and prior cerebrovascular ischemia, the patient achieved progressive hemodynamic stabilization, durable suppression of inflammatory markers, and continued disease control. The potential immunomodulatory and antioxidant properties of HydroBox-assisted therapy warrant further prospective investigation to establish standardized protocols and confirm efficacy in larger cohorts.

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Cite

BibTeXRIS
BibTeX
@article{liao2026sustained,
  title = {{Sustained Tocilizumab and Adjunctive HydroBox Therapy in Refractory Takayasu Arteritis: An 11-year Case Report}},
  author = {CHEN-YU LIAO and JENG-WEI LU and YI-JUNG HO and SHAN-WEN LUI and TING-YU HSIEH and WUN-LONG JHENG and FENG-CHENG LIU},
  journal = {In Vivo},
  year = {2026},
  month = oct,
  doi = {10.21873/invivo.14530},
  url = {https://doi.org/10.21873/invivo.14530},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Sustained Tocilizumab and Adjunctive HydroBox Therapy in Refractory Takayasu Arteritis: An 11-year Case Report
AU  - CHEN-YU LIAO
AU  - JENG-WEI LU
AU  - YI-JUNG HO
AU  - SHAN-WEN LUI
AU  - TING-YU HSIEH
AU  - WUN-LONG JHENG
AU  - FENG-CHENG LIU
PY  - 2026
DA  - 2026/10/29
JO  - In Vivo
DO  - 10.21873/invivo.14530
UR  - https://doi.org/10.21873/invivo.14530
AB  - Background/Aim: Takayasu arteritis (TAK) is a rare, chronic granulomatous large-vessel vasculitis predominantly affecting young women, characterized by progressive stenosis and occlusion of the aorta and its major branches. Despite advances in biologic therapy, refractory disease with recurrent vascular complications remains a significant clinical challenge. Molecular hydrogen-based adjuvant (HydroBox) therapy has emerged as a promising adjuvant approach owing to its antioxidant and immunomodulatory properties. This report aims to describe the long-term clinical course and therapeutic outcomes of a patient with refractory TAK managed with sustained tocilizumab and HydroBox-assisted immunomodulatory therapy over 11 years.  Case Report: We report the case of a 25-year-old female with refractory TAK first diagnosed at age 13, presenting with sudden vision loss, dizziness, and pulseless upper extremities. Disease course was complicated by extensive great-vessel involvement, multiple cerebral infarctions, and recurrent in-stent restenosis despite ongoing interleukin-6 (IL-6) blockade. Over 50 courses of tocilizumab (Actemra) were administered from 2014 onward, combined with multiple percutaneous transluminal angioplasty and stenting procedures. HydroBox-assisted immunomodulatory therapy was subsequently introduced as an adjunctive treatment. During continued follow-up, the patient remained clinically stable with sustained suppression of inflammatory markers and favorable cerebrovascular findings on serial imaging.  Conclusion: This 11-year case report documents the feasibility of sustained long-term tocilizumab therapy combined with adjunctive HydroBox therapy in a patient with refractory TAK. Despite extensive multi-vessel involvement, recurrent in-stent restenosis, and prior cerebrovascular ischemia, the patient achieved progressive hemodynamic stabilization, durable suppression of inflammatory markers, and continued disease control. The potential immunomodulatory and antioxidant properties of HydroBox-assisted therapy warrant further prospective investigation to establish standardized protocols and confirm efficacy in larger cohorts.
SN  - 0258-851X
SN  - 1791-7549
ER  -