Current and emerging therapies in large-vessel vasculitis

Area of Science:

• Rheumatology
• Immunology
• Vascular Medicine

Background:

• Giant cell arteritis (GCA), polymyalgia rheumatica (PMR), and Takayasu arteritis share clinical features and are primarily treated with glucocorticoids.
• Chronic glucocorticoid use leads to significant morbidity, necessitating alternative therapeutic strategies.
• Existing conventional immunosuppressants offer only modest benefits for these relapsing conditions.

Purpose of the Study:

• To review the current treatment landscape for GCA, PMR, and Takayasu arteritis.
• To explore the potential of biologic therapies, particularly IL-6 antagonists, as novel treatment options.
• To highlight challenges in assessing disease activity and the need for long-term outcome data.

Main Methods:

• Review of existing literature on GCA, PMR, and Takayasu arteritis treatments.
• Analysis of data from recent randomized clinical trials, including those for Takayasu arteritis.
• Discussion of the role of biologic agents, focusing on IL-6 antagonists.

Main Results:

• Glucocorticoids remain the standard therapy but are associated with significant adverse effects.
• Biologic therapies, specifically IL-6 antagonists, have demonstrated efficacy in PMR and GCA.
• Recent trials in Takayasu arteritis suggest potential for new treatment avenues.

Conclusions:

• There is a critical need for improved therapies to induce and maintain remission in GCA, PMR, and Takayasu arteritis with reduced glucocorticoid toxicity.
• Biologic agents represent a promising therapeutic class, with IL-6 antagonists showing particular potential.
• Further long-term studies are essential to evaluate the impact of biologics on clinical outcomes, including vascular damage, cost-effectiveness, and quality of life, and to determine optimal treatment durations.