Current and Future Treatments for Takayasu Arteritis: Toward Cardiovascular Risk Modification.

Area of Science:

• Rheumatology and Immunology
• Cardiovascular Medicine
• Vascular Biology

Background:

• Takayasu arteritis (TAK) is a rare, immune-mediated large-vessel vasculitis primarily affecting young women.
• It carries a significant risk of vascular complications and long-term cardiovascular disease.
• Current treatments, including glucocorticoids and immunosuppressants, have high relapse rates and inadequately address future cardiovascular risk.

Purpose of the Study:

• To synthesize evidence on current Takayasu arteritis treatment strategies and unmet needs.
• To explore novel immunological and vascular-targeted therapies.
• To advocate for a management paradigm shift towards integrated cardiovascular risk reduction.

Main Methods:

• Review of current literature on Takayasu arteritis pathogenesis, diagnosis, and treatment.
• Critical appraisal of existing therapies (glucocorticoids, DMARDs, biologics).
• Exploration of emerging therapies targeting novel inflammatory and signaling pathways.

Main Results:

• Advances in understanding TAK pathogenesis highlight roles of innate and adaptive immunity.
• Emerging therapies target pathways like IL-17, IL-12/23, JAK/STAT, and Notch-1/mTOR.
• Cardiovascular morbidity is a major contributor to mortality in TAK, necessitating integrated risk factor modification.

Conclusions:

• Current Takayasu arteritis management is limited by diagnostic uncertainty, heterogeneous approaches, and lack of high-quality trials.
• Future interventions must target both immune-mediated vascular injury and cardiovascular disease progression.
• Achieving long-term disease remission and reducing cardiovascular mortality should be the primary therapeutic goals.