[Recent advances in the treatment of large vessel vasculitides]
Melinda Zsuzsanna Szabó1, Emese Kiss1
1Országos Reumatológiai és Fizioterápiás Intézet Budapest, Frankel Leó u. 38-40., 1023.
Insights
Giant cell arteritis and Takayasu arteritis, types of large vessel vasculitis, may be related. New biologic therapies like IL-6 inhibitors show promise for managing these conditions when standard treatments fail.
Area of Science:
- Rheumatology
- Immunology
- Internal Medicine
Background:
- Giant cell arteritis (GCA) and Takayasu arteritis (TA) are large vessel vasculitides with similar histopathology.
- Current treatments rely on glucocorticoids, often leading to dependence and side effects.
- Alternative therapies are needed for patients unresponsive to conventional disease-modifying antirheumatic drugs (DMARDs).
Purpose of the Study:
- To review recent advancements in the treatment of large vessel vasculitides.
- To evaluate the efficacy of novel biologic agents in GCA and TA.
- To identify potential alternative therapeutic options for refractory cases.
Main Methods:
- Literature review of current treatment strategies for large vessel vasculitides.
- Analysis of clinical trial data and case reports on biologic therapies.
- Comparison of treatment outcomes for different drug classes.
Main Results:
- Tumor necrosis factor-alpha (TNF-α) inhibitors show efficacy in TA but limited benefit in GCA.
- Interleukin-6 (IL-6) inhibitors demonstrate significant promise for both refractory GCA and TA.
- Abatacept and ustekinumab are also identified as potential therapeutic options.
Conclusions:
- Novel biologic agents offer new avenues for managing large vessel vasculitides.
- IL-6 inhibitors represent a promising treatment for refractory GCA and TA.
- Further research is warranted to establish the long-term efficacy and safety of these emerging therapies.
Abstract:
Giant cell arteritis and Takayasu arteritis classified to large vessel vasculitides have similar histopathology in the vascular wall proposing that these entities can be different phenotypes on a spectrum of a single disorder. Glucocorticoids are the mainstay of therapy combined with cyclophosphamide, azatioprine and mycofenolate mofetil, when it is required. However, a significant proportion of patients are glucocorticoid-dependent despite of the conventional disease-modifying antirheumatic drugs and suffer from serious side effects of the steroids, therefore alternate options for more effective disease management are needed. The article reviews the advances in the treatment of large vessel vasculitides. Tumor necrosis factor-alpha inhibitors seem to be effective in Takayasu arteritis, but have a little benefit in giant cell arteritis. Interleukin-6 inhibitor appears very promising in both refractory giant cell arteritis and Takayasu arteritis as well. Abatacept and ustekinumab also seem to be a good choice for the therapy. Orv. Hetil., 2017, 158(1), 5-12.
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