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Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis
Alexandre Wagner S de Souza1, Emilia I Sato1, Maria Lorena Brance2
1From the Rheumatology Division, Universidad Federal de São Paulo, São Paulo, Brazil.
Insights
The first Pan American League of Associations for Rheumatology (PANLAR) guidelines offer evidence-based treatment recommendations for Takayasu arteritis (TAK). These guidelines cover initial treatment, managing relapses, and preventing complications in TAK patients.
Area of Science:
- Rheumatology
- Immunology
- Vascular Medicine
Background:
- Takayasu arteritis (TAK) is a rare, chronic inflammatory disease affecting large arteries.
- Effective management strategies are crucial to prevent severe complications and improve patient outcomes.
Conclusions:
- These represent the first PANLAR guidelines for Takayasu arteritis treatment.
- The guidelines offer evidence-based direction for managing TAK patients, particularly in Latin America.
Objective:
To develop the first evidence-based Pan American League of Associations for Rheumatology (PANLAR) guidelines for the treatment of Takayasu arteritis (TAK).
Methods:
A panel of vasculitis experts developed a series of clinically meaningful questions addressing the treatment of TAK patients in the PICO (population/intervention/comparator/outcome) format. A systematic literature review was performed by a team of methodologists. The evidence quality was assessed according to the GRADE (Grading of Recommendations/Assessment/Development/Evaluation) methodology. The panel of vasculitis experts voted each PICO question and made recommendations, which required ≥70% agreement among the voting members.
Results:
Eleven recommendations were developed. Oral glucocorticoids are conditionally recommended for newly diagnosed and relapsing TAK patients. The addition of nontargeted synthetic immunosuppressants (e.g., methotrexate, leflunomide, azathioprine, or mycophenolate mofetil) is recommended for patients with newly diagnosed or relapsing disease that is not organ- or life-threatening. For organ- or life-threatening disease, we conditionally recommend tumor necrosis factor inhibitors (e.g., infliximab or adalimumab) or tocilizumab with consideration for short courses of cyclophosphamide as an alternative in case of restricted access to biologics. For patients relapsing despite nontargeted synthetic immunosuppressants, we conditionally recommend to switch from one nontargeted synthetic immunosuppressant to another or to add tumor necrosis factor inhibitors or tocilizumab. We conditionally recommend low-dose aspirin for patients with involvement of cranial or coronary arteries to prevent ischemic complications. We strongly recommend performing surgical vascular interventions during periods of remission whenever possible.
Conclusion:
The first PANLAR treatment guidelines for TAK provide evidence-based guidance for the treatment of TAK patients in Latin American countries.
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