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Phenotypic clusters of patients with Takayasu arteritis predict disease activity at presentation, damage and future
Aysegul Avcu1, Augustine Jose2, Sachit Ganapathy3
1Division of Rheumatology, Department of Internal Medicine, Marmara University, School of Medicine, Istanbul, Türkiye.
Insights
This study identified three distinct patient clusters for Takayasu arteritis (TAK) based on clinical and angiographic features. These clusters show varying disease patterns and prognoses, aiding in personalized treatment strategies for TAK.
Area of Science:
- Rheumatology
- Vascular Medicine
- Immunology
Background:
- Takayasu arteritis (TAK) is a rare, chronic inflammatory condition affecting large arteries.
- Understanding TAK heterogeneity is crucial for predicting disease course and outcomes.
Purpose of the Study:
- To identify distinct patient clusters in Takayasu arteritis (TAK) using clinical and angiographic data.
- To evaluate the prognostic relevance of these identified TAK clusters.
Main Methods:
- Agglomerative hierarchical clustering was applied to phenotype data from 564 TAK patients across three cohorts.
- Clinical features, angiographic involvement, disease activity, Vasculitis Damage Index (VDI), treatment initiation, vascular procedures, and complications were analyzed.
- Mortality rates were assessed using Cox regression analysis.
Main Results:
- Three primary clusters (1, 2, with sub-clusters 2A, 2B) were identified, differing in age, sex distribution, and affected arterial segments.
- Cluster 2A showed less severe disease with lower rates of medication initiation and complications compared to Cluster 1.
- Cluster 2B exhibited more extensive disease, higher VDI, and increased need for vascular interventions.
- Overall survival rates were similar across all identified clusters.
Conclusions:
- Phenotypic clustering of Takayasu arteritis patients reveals distinct patterns of angiographic involvement.
- These identified clusters possess prognostic implications, potentially guiding tailored therapeutic approaches for TAK.
Objective:
To identify clusters of Takayasu arteritis (TAK) based on clinical features and their prognostic relevance.
Methods:
Using agglomerative hierarchical clustering, clusters were defined by phenotype at presentation from 564 patients with TAK from three cohorts from India and Türkiye. Angiographic involvement, disease activity and Vasculitis Damage Index (VDI) at presentation, initiation of glucocorticoids or immunosuppressive agents, requirement for vascular procedures, and new-onset vascular complications were compared between clusters [unpaired Student's t-test or odds ratios (OR) with 95% CI]. Mortality rates [hazard ratios (HR) with 95%CI] were computed using Cox regression.
Results:
Three clusters were identified (1 and 2, with sub-clusters 2A and 2B). Cluster 2 was younger and comprised relatively fewer women than cluster 1. Clinical features and angiography in cluster 1 reflected more frequent involvement of the aortic arch and its branches as opposed to a greater involvement of the abdominal aorta and its branches in cluster 2. Cluster 2B more often had pan-aortic disease and left subclavian involvement than 2A. Fewer patients in cluster 2A were initiated on glucocorticoids [OR adjusted for centre (aOR) 0.51 (95% CI: 0.31, 0.83)] or immunosuppressants [aOR 0.35 (95% CI: 0.20, 0.60)] or developed new-onset vascular complications [aOR 0.22 (95% CI: 0.07, 0.74)] than in cluster 1. Cluster 2B had higher VDI (3.98) than clusters 1 (3.50) or 2A (2.46) and required more frequent vascular interventions than cluster 1 or 2A (aOR 1.73, 1.88, P < 0.05). Survival was similar across clusters [HR 2A vs 1: 0.99 (95% CI: 0.43, 2.29), 2B vs 1: 1.20 (95% CI: 0.84, 1.70)].
Conclusion:
Phenotypic clusters of TAK reflected distinct angiographic involvement with prognostic implications.
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