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Standard and biological treatment in large vessel vasculitis: guidelines and current approaches

Francesco Muratore1, Nicolò Pipitone1, Carlo Salvarani1

  • 1a Rheumatology Unit, Department of Internal Medicine , Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico , Reggio Emilia , Italy.

Expert Review of Clinical Immunology
|January 25, 2017
PubMed

Insights

Giant cell arteritis and Takayasu arteritis treatments are reviewed, highlighting disappointing results from conventional immunosuppressants. Tocilizumab shows promise for relapsing forms, but biological agents are not curative for large vessel vasculitis.

Area of Science:

  • Rheumatology
  • Immunology

Background:

  • Giant cell arteritis (GCA) and Takayasu arteritis (TA) are idiopathic large vessel vasculitides.
  • Glucocorticoids induce remission but lead to frequent relapses and adverse events due to prolonged use.

Purpose of the Study:

  • To review standard and biological treatment strategies for large vessel vasculitis.
  • To focus on current therapeutic approaches for GCA and TA.

Main Methods:

  • Review of treatment trials with conventional immunosuppressive agents.
  • Evaluation of TNF-α blockers and tocilizumab in GCA and TA.

Main Results:

  • Conventional immunosuppressants (methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide) showed disappointing efficacy.
  • TNF-α blockers are ineffective in GCA.
  • Tocilizumab shows promise in relapsing GCA and TA, supported by observational data and a phase 2 trial.
  • Biological agents are not curative, and relapses persist.

Conclusions:

  • Current treatment strategies for large vessel vasculitis, including GCA and TA, require further optimization.
  • Tocilizumab represents a potential therapeutic option for relapsing GCA and TA.
  • Ongoing research is needed to develop curative therapies for these conditions.
Abstract

Keywords:
Large vessel vasculitisTakayasu arteritisanti-TNF-αbiological agentsgiant cell arteritisimmunosuppressive agentstocilizumabtreatment

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