Giant Cell Arteritis Refractory to Interleukin-6 and Interleukin-17 Inhibition Treated With Upadacitinib

Area of Science:

• Rheumatology
• Immunology
• Vascular Medicine

Background:

• Giant cell arteritis (GCA) is a serious vasculitis affecting large arteries.
• Current treatments, including IL-6 receptor blockade, are insufficient for some patients.
• Limited options exist for medically refractory GCA cases.

Observation:

• A patient with extracranial GCA presented with disease refractory to multiple therapies.
• The patient had failed glucocorticoids, azathioprine, tocilizumab (an IL-6 inhibitor), and secukinumab (an IL-17A inhibitor).

Findings:

• The patient achieved robust clinical and imaging remission following treatment with upadacitinib.
• Upadacitinib is a selective Janus kinase 1 (JAK1) inhibitor.
• This is the first reported case of GCA resistant to both IL-6 and IL-17 inhibition but responsive to JAK inhibition.

Implications:

• Upadacitinib demonstrates potential as a novel therapeutic option for refractory GCA.
• JAK inhibition may represent a critical pathway for managing GCA.
• This case expands treatment strategies for patients with difficult-to-treat GCA.