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Biotherapies in large vessel vasculitis.

G Pazzola1, F Muratore1, N Pipitone1

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Summary

Glucocorticoids (GC) are standard for large vessel vasculitides (LVV), but over two-thirds of patients relapse or become dependent. Conventional DMARDs offer limited steroid-sparing effects, while biologics are a viable option for severe or relapsing cases.

Keywords:
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Area of Science:

  • Rheumatology
  • Immunology
  • Internal Medicine

Background:

  • Large vessel vasculitides (LVV) are chronic inflammatory conditions primarily treated with glucocorticoids (GC).
  • Despite initial efficacy, GC therapy is associated with high rates of relapse and dependence in over two-thirds of LVV patients.
  • Conventional synthetic disease-modifying antirheumatic drugs (DMARDs) have demonstrated minimal steroid-sparing capabilities in LVV management.

Purpose of the Study:

  • To review the current therapeutic landscape for large vessel vasculitides.
  • To evaluate the efficacy of conventional synthetic DMARDs and biological agents in managing LVV.
  • To highlight the role of alternative therapies in reducing glucocorticoid burden and improving patient outcomes.

Main Methods:

  • Literature review of clinical trials and observational studies.
  • Analysis of data on treatment response, relapse rates, and steroid dependence.
  • Comparative assessment of conventional synthetic DMARDs and biological agents in LVV.

Main Results:

  • Glucocorticoids (GC) are the primary treatment for LVV, achieving initial remission in most patients.
  • Over two-thirds of patients experience relapses or become dependent on GC therapy.
  • Conventional synthetic DMARDs show limited efficacy in reducing GC requirements.
  • Biological agents offer a promising therapeutic avenue for severe or relapsing cases of LVV.

Conclusions:

  • Current LVV treatment relies heavily on glucocorticoids, leading to significant long-term complications.
  • Conventional synthetic DMARDs have not proven effective as steroid-sparing agents in LVV.
  • Biological agents represent a valuable therapeutic option for refractory or relapsing LVV, potentially reducing GC dependence and improving disease control.