Biological therapy in Takayasu arteritis. Results from the REVAS registry

Biological therapy in patients with Takayasu arteritis is frequently used, but the factors associated with its use have not been determined. The present study aims to describe and identify predictors of the need for biological therapy in this vasculitis. We conducted a retrospective, multicentre, descriptive study including all patients with Takayasu arteritis enrolled in the REVAS registry from Spain. We performed a descriptive and a multivariate logistic regression analysis to identify variables associated with the need of biological therapy requirement. The study included 77 patients, 65 (84.4 %) women, with a median follow up of 9.9 (interquartile range 3.5-21.5) years. Sixty-three (81.8 %) participants received glucocorticoids and 45 (58.4 %) needed immunosuppressive therapy. Twenty-three patients had received biological therapy, 20 of whom were diagnosed after 2006. Biological therapy included infliximab (n = 3), adalimumab (n = 9) and tocilizumab (n = 18). Patients requiring biological therapy had a higher proportion of systemic symptoms (fever and/or constitutional syndrome) at baseline (70.0 %vs. 28.6 %, p = 0.005), received glucocorticoids more frequently (100.0 %vs. 78.6 %, p = 0.03) and required a greater number of immunosuppressants (2 (1-2) vs. 1 (0-1), p = 0.03) during follow-up. On multivariate logistic regression, the presence of systemic symptoms was associated with the need for biological therapy requirement (odds radio: 3.9 (1.02-14.8), p = 0.047). Conclusion: to our knowledge, this is the first study that evaluates variables associated with the need for biological therapy requirement in Takayasu arteritis. The presence of systemic symptoms at presentation was independently associated with the need for biological therapy, highlighting the importance of a thorough clinical evaluation.