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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis

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Comparing treatment options for large vessel vasculitis

Federica Macaluso1,2, Chiara Marvisi1,3, Paola Castrignanò1,3

  • 1Rheumatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.

Expert Review of Clinical Immunology
|June 17, 2022
PubMed

Insights

Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are large vessel vasculitis (LVV) treated with glucocorticoids. Conventional and biologic immunosuppressants, like tocilizumab, offer a glucocorticoid-sparing effect, reducing relapses and side effects in LVV management.

Area of Science:

  • Rheumatology
  • Immunology
  • Internal Medicine

Background:

  • Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are primary forms of large vessel vasculitis (LVV).
  • Glucocorticoids are the standard treatment for LVV, but their long-term use leads to frequent relapses and significant side effects.
  • There is a need for effective glucocorticoid-sparing strategies to manage LVV and mitigate treatment-related complications.

Purpose of the Study:

  • To review current evidence on the management of large vessel vasculitis (LVV), focusing on therapeutic strategies for GCA and TAK.
  • To highlight differences in therapeutic approaches between GCA and TAK.
  • To evaluate the role of conventional and biologic immunosuppressive drugs as glucocorticoid-sparing agents in LVV.

Main Methods:

  • A literature search was conducted on PubMed using keywords related to drug therapy and surgery for GCA and TAK.
  • The review synthesizes current evidence on LVV management, comparing treatment options for GCA and TAK.
  • Focus is placed on evaluating the efficacy of immunosuppressive agents in reducing glucocorticoid dependence and disease recurrence.

Main Results:

  • Conventional disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate and azathioprine are recommended for GCA and TAK patients alongside glucocorticoids.
  • Tocilizumab has demonstrated efficacy in reducing relapses and cumulative prednisone dosage in both new-onset and relapsing GCA.
  • Evidence suggests TNF-alpha inhibitors and tocilizumab can act as glucocorticoid-sparing agents in relapsing TAK, though high-quality data is limited.

Conclusions:

  • Conventional DMARDs and biologic agents like tocilizumab are valuable in managing GCA and TAK, offering a glucocorticoid-sparing effect.
  • Tocilizumab shows significant promise in reducing relapses and steroid burden in GCA.
  • Further high-quality research is needed to establish definitive treatment guidelines for TAK, particularly regarding biologic therapies.
Abstract

Keywords:
Biologicsgiant cell arteritisglucocorticoidslarge vessels vasculitistakayasu arteritistreatment

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