The management of large vessel vasculitides

https://doi.org/10.4081/br.2021.51

Authors

  • Elena Galli | gallielena90@gmail.com Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
  • Chiara Marvisi Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy. https://orcid.org/0000-0001-7027-1410
  • Gilda Sandri Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy. https://orcid.org/0000-0003-0454-1093
  • Carlo Umberto Manzini Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
  • Carlo Salvarani Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy.

Abstract

Giant cell arteritis (GCA) and Takayasu arteritis (TAK) represent the most common large vessel vasculitides (LVV). An early recognition of these conditions is crucial in order to start a prompt treatment to prevent severe ischemic complications, such as irreversible visual loss in GCA and cardiovascular or cerebrovascular accidents in TAK. Isolated glucocorticoids (GCs) still remain the cornerstone of GCA therapy. However, long-term treatment with GCs is burdened by an important toxicity. Furthermore, relapses are frequent during the follow-up period and relapsing patients have to cope with a longer duration of the GC therapy and a higher cumulative GC dose. On the other hand, TAK treatment usually relies on immunosuppressors in addition to GCs from the beginning. Also, since TAK patients are in general young women with a progressive disease, it is essential to treat this vasculitis with steroidsparing drugs in order to avoid excessive GC exposure. For this reason, efforts have been made to discover new therapeutic options able to reduce the cumulative GC dose that is strictly related to GC-toxicity. In recent years, new advances in the management of LVV have become available and have changed the therapeutic approach to these diseases. The aim of this review is to report new evidence of treatment efficacy and safety in LVV.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

References

Kermani TA. Takayasu arteritis and giant cell arteritis: are they a spectrum of the same disease? Int J Rheum Dis 2019;22 Suppl 1:41-8. DOI: https://doi.org/10.1111/1756-185X.13288

Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet Lond Engl 2008;372:234-45. DOI: https://doi.org/10.1016/S0140-6736(08)61077-6

Goel R, Danda D, Joseph G, et al. Long-term outcome of 251 patients with Takayasu arteritis on combination immunosuppressant therapy: Single centre experience from a large tertiary care teaching hospital in Southern India. Semin Arthritis Rheum 2018;47:718-26. DOI: https://doi.org/10.1016/j.semarthrit.2017.09.014

Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med 2002;347:261-71. DOI: https://doi.org/10.1056/NEJMra011913

Salvarani C, Pipitone N, Versari A, Hunder GG. Clinical features of polymyalgia rheumatica and giant cell arteritis. Nat Rev Rheumatol 2012;8:509-21. DOI: https://doi.org/10.1038/nrrheum.2012.97

Proven A, Gabriel SE, Orces C, O’Fallon WM, Hunder GG. Glucocorticoid therapy in giant cell arteritis: Duration and adverse outcomes. Arthritis Rheum 2003;49:703-8. DOI: https://doi.org/10.1002/art.11388

Muratore F, Boiardi L, Restuccia G, et al. Relapses and long-term remission in large vessel giant cell arteritis in northern Italy: Characteristics and predictors in a long-term follow-up study. Semin Arthritis Rheum 2020;50:549-58. DOI: https://doi.org/10.1016/j.semarthrit.2020.04.004

Jover JA, Hernández-García C, Morado IC, et al. Combined treatment of giant-cell arteritis with methotrexate and prednisone. a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2001;134:106-14. DOI: https://doi.org/10.7326/0003-4819-134-2-200101160-00010

Hoffman GS, Cid MC, Hellmann DB, et al. A multicenter, randomized, double-blind, placebo-controlled trial of adjuvant methotrexate treatment for giant cell arteritis. Arthritis Rheum 2002;46:1309-18. DOI: https://doi.org/10.1002/art.10262

Spiera RF, Mitnick HJ, Kupersmith M, et al. A prospective, double-blind, randomized, placebo controlled trial of methotrexate in the treatment of giant cell arteritis (GCA). Clin Exp Rheumatol 2001;19:495-501.

Mahr AD, Jover JA, Spiera RF, et al. Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data meta-analysis. Arthritis Rheum 2007;56:2789-97. DOI: https://doi.org/10.1002/art.22754

Hellmich B, Agueda A, Monti S, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2020;79:19-30. DOI: https://doi.org/10.1136/annrheumdis-2019-215672

Diamantopoulos AP, Hetland H, Myklebust G. Leflunomide as a corticosteroid-sparing agent in giant cell arteritis and polymyalgia rheumatica: a case series. BioMed Res Int 2013;2013:120638. DOI: https://doi.org/10.1155/2013/120638

Adizie T, Christidis D, Dharmapaliah C, et al. Efficacy and tolerability of leflunomide in difficult-to-treat polymyalgia rheumatica and giant cell arteritis: a case series. Int J Clin Pract 2012;66:906-9. DOI: https://doi.org/10.1111/j.1742-1241.2012.02981.x

Hočevar A, Ješe R, Rotar Ž, Tomšič M. Does leflunomide have a role in giant cell arteritis? An open-label study. Clin Rheumatol 2019;38:291-6. DOI: https://doi.org/10.1007/s10067-018-4232-x

Monti S, Águeda AF, Luqmani RA, et al. Systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis: focus on giant cell arteritis. RMD Open 2019;5:e001003. DOI: https://doi.org/10.1136/rmdopen-2019-001003

Schaufelberger C, Andersson R, Nordborg E. No additive effect of cyclosporin A compared with glucocorticoid treatment alone in giant cell arteritis: results of an open, controlled, randomized study. Br J Rheumatol 1998;37:464-5. DOI: https://doi.org/10.1093/rheumatology/37.4.464

Schaufelberger C, Möllby H, Uddhammar A, et al. No additional steroid-sparing effect of cyclosporine A in giant cell arteritis. Scand J Rheumatol 2006;35:327-9. DOI: https://doi.org/10.1080/03009740500474537

De Silva M, Hazleman BL. Azathioprine in giant cell arteritis/polymyalgia rheumatica: a double-blind study. Ann Rheum Dis 1986;45:136-8. DOI: https://doi.org/10.1136/ard.45.2.136

Weyand CM, Fulbright JW, Hunder GG, et al. Treatment of giant cell arteritis: interleukin-6 as a biologic marker of disease activity. Arthritis Rheum 2000;43:1041-8. DOI: https://doi.org/10.1002/1529-0131(200005)43:5<1041::AID-ANR12>3.0.CO;2-7

Weyand CM, Goronzy JJ. Medium- and large-vessel vasculitis. N Engl J Med 2003;349:160-9. DOI: https://doi.org/10.1056/NEJMra022694

Salvarani C, Cantini F, Boiardi L, Hunder GG. Laboratory investigations useful in giant cell arteritis and Takayasu’s arteritis. Clin Exp Rheumatol 2003;21:S23-8.

Boiardi L, Casali B, Farnetti E, et al. Relationship between interleukin 6 promoter polymorphism at position -174, IL-6 serum levels, and the risk of relapse/recurrence in polymyalgia rheumatica. J Rheumatol 2006;33:703-8.

Salvarani C, Magnani L, Catanoso M, et al. Tocilizumab: a novel therapy for patients with large-vessel vasculitis. Rheumatology 2012;51:151-6. DOI: https://doi.org/10.1093/rheumatology/ker296

Unizony S, Arias-Urdaneta L, Miloslavsky E, et al. Tocilizumab for the treatment of large-vessel vasculitis (giant cell arteritis, Takayasu arteritis) and polymyalgia rheumatica. Arthritis Care Res 2012;64:1720-9. DOI: https://doi.org/10.1002/acr.21750

Villiger PM, Adler S, Kuchen S, et al. Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet Lond Engl 2016;387:1921-7. DOI: https://doi.org/10.1016/S0140-6736(16)00560-2

Stone JH, Tuckwell K, Dimonaco S, et al. Trial of tocilizumab in giant-cell arteritis. N Engl J Med 2017;377:317-28. DOI: https://doi.org/10.1056/NEJMoa1613849

Salvarani C, Hatemi G. Management of large-vessel vasculitis. Curr Opin Rheumatol 2019;31:25-31. DOI: https://doi.org/10.1097/BOR.0000000000000561

Hoffman GS, Cid MC, Rendt-Zagar KE, et al. Infliximab for maintenance of glucocorticosteroid-induced remission of giant cell arteritis: a randomized trial. Ann Intern Med 2007;146:621-30. DOI: https://doi.org/10.7326/0003-4819-146-9-200705010-00004

Seror R, Baron G, Hachulla E, et al. Adalimumab for steroid sparing in patients with giant-cell arteritis: results of a multicentre randomised controlled trial. Ann Rheum Dis 2014;73:2074-81. DOI: https://doi.org/10.1136/annrheumdis-2013-203586

Martínez-Taboada VM, Rodríguez-Valverde V, Carreño L, et al. A double-blind placebo controlled trial of etanercept in patients with giant cell arteritis and corticosteroid side effects. Ann Rheum Dis 2008;67:625-30. DOI: https://doi.org/10.1136/ard.2007.082115

Langford CA, Cuthbertson D, Ytterberg SR, et al. A Randomized, Double-Blind Trial of Abatacept (CTLA-4Ig) for the Treatment of Giant Cell Arteritis. Arthritis Rheumatol Hoboken NJ 2017;69:837-45. DOI: https://doi.org/10.1002/art.40044

Conway R, O’Neill L, Gallagher P, et al. Ustekinumab for refractory giant cell arteritis: A prospective 52-week trial. Semin Arthritis Rheum 2018;48:523-8. DOI: https://doi.org/10.1016/j.semarthrit.2018.04.004

Zhang H, Watanabe R, Berry GJ, et al. Inhibition of JAK-STAT signaling suppresses pathogenic immune responses in medium and large vessel vasculitis. Circulation 2018;137:1934-48. DOI: https://doi.org/10.1161/CIRCULATIONAHA.117.030423

Kerr GS, Hallahan CW, Giordano J, et al. Takayasu arteritis. Ann Intern Med 1994;120:919-29. DOI: https://doi.org/10.7326/0003-4819-120-11-199406010-00004

Hoffman GS, Leavitt RY, Kerr GS, et al. Treatment of glucocorticoid-resistant or relapsing Takayasu arteritis with methotrexate. Arthritis Rheum 1994;37:578-82. DOI: https://doi.org/10.1002/art.1780370420

Valsakumar AK, Valappil UC, Jorapur V, et al. Role of immunosuppressive therapy on clinical, immunological, and angiographic outcome in active Takayasu’s arteritis. J Rheumatol 2003;30:1793-8.

de Souza AWS, de Almeida Agustinelli R, de Cinque Almeida H, et al. Leflunomide in Takayasu arteritis - A long term observational study. Rev Bras Reumatol Engl Ed 2016;56:371-5. DOI: https://doi.org/10.1016/j.rbr.2015.09.007

Dai D, Wang Y, Jin H, et al. The efficacy of mycophenolate mofetil in treating Takayasu arteritis: a systematic review and meta-analysis. Rheumatol Int 2017;37:1083-8. DOI: https://doi.org/10.1007/s00296-017-3704-7

Sun Y, Ma L, Ma L, et al. Cyclophosphamide could be a better choice than methotrexate as induction treatment for patients with more severe Takayasu’s arteritis. Rheumatol Int 2017;37:2019-26. DOI: https://doi.org/10.1007/s00296-017-3847-6

Hoffman GS, Merkel PA, Brasington RD, et al. Anti-tumor necrosis factor therapy in patients with difficult to treat Takayasu arteritis. Arthritis Rheum 2004;50:2296-304. DOI: https://doi.org/10.1002/art.20300

Molloy ES, Langford CA, Clark TM, et al. Anti-tumour necrosis factor therapy in patients with refractory Takayasu arteritis: long-term follow-up. Ann Rheum Dis 2008;67:1567-9. DOI: https://doi.org/10.1136/ard.2008.093260

Schmidt J, Kermani TA, Kirstin Bacani A, et al. Tumor necrosis factor inhibitors in patients with Takayasu arteritis: Experience from a referral center with long-term follow-up. Arthritis Care Res 2012;n/a-n/a. DOI: https://doi.org/10.1002/acr.21636

Clifford A, Hoffman GS. Recent advances in the medical management of Takayasu arteritis: an update on use of biologic therapies. Curr Opin Rheumatol 2014;26:7-15. DOI: https://doi.org/10.1097/BOR.0000000000000004

Gudbrandsson B, Molberg Ø, Palm Ø. TNF inhibitors appear to inhibit disease progression and improve outcome in Takayasu arteritis; an observational, population-based time trend study. Arthritis Res Ther 2017;19:99. DOI: https://doi.org/10.1186/s13075-017-1316-y

Hoyer BF, Mumtaz IM, Loddenkemper K, et al. Takayasu arteritis is characterised by disturbances of B cell homeostasis and responds to B cell depletion therapy with rituximab. Ann Rheum Dis 2012;71:75-9. DOI: https://doi.org/10.1136/ard.2011.153007

Pazzola G, Muratore F, Pipitone N, et al. Rituximab therapy for Takayasu arteritis: a seven patients experience and a review of the literature. Rheumatology 2018;57:1151-5. DOI: https://doi.org/10.1093/rheumatology/kex249

Nakaoka Y, Isobe M, Takei S, et al. Efficacy and safety of tocilizumab in patients with refractory Takayasu arteritis: results from a randomised, double-blind, placebo-controlled, phase 3 trial in Japan (the TAKT study). Ann Rheum Dis 2018;77:348-54. DOI: https://doi.org/10.1136/annrheumdis-2017-211878

Mekinian A, Resche-Rigon M, Comarmond C, et al. Efficacy of tocilizumab in Takayasu arteritis: Multicenter retrospective study of 46 patients. J Autoimmun 2018;91:55-60. DOI: https://doi.org/10.1016/j.jaut.2018.04.002

Langford CA, Cuthbertson D, Ytterberg SR, et al. A Randomized, double‐blind trial of abatacept (CTLA‐4Ig) for the treatment of Takayasu arteritis. Arthritis Rheumatol 2017;69:846-53. DOI: https://doi.org/10.1002/art.40037

Terao C, Yoshifuji H, Nakajima T, et al. Ustekinumab as a therapeutic option for Takayasu arteritis: from genetic findings to clinical application. Scand J Rheumatol 2016;45:80-2. DOI: https://doi.org/10.3109/03009742.2015.1060521

Jung JH, Lee YH, Song GG, et al. Endovascular versus open surgical intervention in patients with takayasu’s arteritis: a meta-analysis. Eur J Vasc Endovasc Surg 2018;55:888-99. DOI: https://doi.org/10.1016/j.ejvs.2018.02.030

Jeong HS, Jung JH, Song GG, et al. Endovascular balloon angioplasty versus stenting in patients with Takayasu arteritis: a meta-analysis. Medicine (Baltimore) 2017;96:e7558. DOI: https://doi.org/10.1097/MD.0000000000007558

Downloads

Published
2021-04-08
Info
Issue
Section
Reviews
Keywords:
Giant cell arteritis, Takayasu arteritis, large vessel vasculitides therapy.
Statistics
  • Abstract views: 1959

  • PDF: 123
How to Cite
Galli, E., Marvisi, C., Sandri, G., Manzini, C. U., & Salvarani, C. (2021). The management of large vessel vasculitides. Beyond Rheumatology, 3(1). https://doi.org/10.4081/br.2021.51

Most read articles by the same author(s)