Biotherapies in large vessel vasculitis

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.