New treatment strategies in large-vessel vasculitis

  title={New treatment strategies in large-vessel vasculitis},
  author={Sebastian H. Unizony and John H. Stone and James R. Stone},
  journal={Current Opinion in Rheumatology},
Purpose of reviewRecent advancements in the understanding of the pathogenesis of large-vessel vasculitis may broaden our currently limited therapeutic possibilities. This review summarizes the available evidence for new treatment strategies in this spectrum of diseases. Recent findingsInterleukin (IL) 6 appears to be an important mediator of the pathology in large-vessel vasculitis. IL-6 is upregulated in inflamed arteries of patients with giant cell arteritis and Takayasu arteritis, and serum… 

Current and emerging diagnosis tools and therapeutics for giant cell arteritis

The recombinant humanized anti-IL-6 receptor antibody is the most frequently used biologic agent in GCA, which is effective to improve clinical symptoms, decrease the cumulative prednisone dose, and reduce the frequency of relapses in patients with GCA.

Great Vessels of Children: Takayasu's Arteritis.

A patient with Takayasu's arteritis who responded to therapy with infliximab, an inhibitor of tumor necrosis factor is described, indicating a strong role for cell-mediated autoimmunity in the pathogenesis of this disease.

Treatment of giant-cell arteritis, a literature review

A review on an international literature about the treatment of giant-cell arteritis, whatever the clinical pattern might be, finds Methotrexate is one of the most used treatments despite its low level of evidence and mild efficacy.

Recent advances in the medical management of Takayasu arteritis: an update on use of biologic therapies

Anti-TNF agents are recommended for the treatment of Takayasu's patients who are unable to taper prednisone despite treatment with a nonbiologic immunosuppressive medication, and may also be of benefit in refractory patients.

Clinical Diagnosis and Management of Large Vessel Vasculitis: Takayasu Arteritis

Takayasu arteritis is 1 of the 2 main causes of large vessel vasculitides (LVV), giant cell arteritis being the other, and other less commonly encountered causes of LVV are also briefly discussed in this review.

Tocilizumab for the treatment of giant cell arteritis

A two randomized controlled trials recently showed the efficacy of the IL-6 receptors inhibitor monoclonal antibody TCZ for the induction and maintenance of remission in patients with new-onset and relapsing GCA, and addition of TCZ to prednisone led to a reduction in the cumulativeprednisone doses required to control GCA.

Biologic Therapies for Giant Cell Arteritis

A review article looks at the existing evidence for biologic agents in giant cell arteritis and the potential role of ustekinumab, abatacept, JAK inhibitors and other promising biologics in GCA.

The Role of Biological Agents in the Management of Large Vessel Vasculitis (LVV): A Systematic Review and Meta-Analysis

Tocilizumab and infliximab may be effective in the management of LVV and refractory TAA, respectively, although the evidence comes from case series, which demonstrates a weak evidence base on which to assess the effectiveness of biological treatment in LVV.

Biologic Therapy for the Treatment of Giant Cell Arteritis

Interleukin-6 (IL-6) inhibition shows the most promise as biologic therapy for refractory cases of GCA, but data to support the use of other existing biologic agents are currently lacking.

Tocilizumab in refractory aortitis: study on 16 patients and literature review.

TCZ appears to be effective and relatively safe in patients with inflammatory aortitis refractory to corticosteroids or to other biologic immunosuppressive drugs.



Biologic treatment of large-vessel vasculitides

Blocking TNF may provide benefit to difficult-to-treat patients with Takayasu's arteritis, relapsing polychondritis and Behcet's disease-associated LVV and the use of TOC monotherapy to induce remission in untreated GCA patients proves fascinating.

Anti-interleukin 6 receptor therapy as rescue treatment for giant cell arteritis

The effects of anti-IL-6 receptor therapy with tocilizumab in three patients with refractory GCA showed excellent initial response, but the team could not taper prednisone to doses less than 30 mg/day.

Tocilizumab: a novel therapy for patients with large-vessel vasculitis.

In this small group of patients with LVV, treatment with TCZ was effective and well tolerated, and PET/CT findings significantly improved in all cases.

Rescue treatment with tocilizumab for Takayasu arteritis resistant to TNF-α blockers.

A patient with TA refractory to multiple conventional immunosuppressive agents and two TNF-α blockers successfully treated with monthly tocilizumab infusions (8 mg/kg body weight) for 6 consecutive months is reported.

Successful treatment of a patient with Takayasu arteritis using a humanized anti-interleukin-6 receptor antibody.

Treating a 20-year-old woman with refractory active TA complicated by ulcerative colitis with the anti-IL-6 receptor antibody tocilizumab improved the clinical manifestations of TA and the abnormal laboratory findings in this patient and ameliorated the activity of UC.

Tissue Cytokine Patterns in Patients with Polymyalgia Rheumatica and Giant Cell Arteritis

Giant cell (temporal) arteritis is the most frequent vasculitic syndrome, with an estimated incidence rate of 15 to 30 cases per 100 000 persons older than 50 years [1, 2]. If not treated promptly,

Interleukin 6 Blockade as Steroid-sparing Treatment for 2 Patients with Giant Cell Arteritis

To the Editor: Giant cell arteritis (GCA) is the most common idiopathic systemic vasculitis of large vessels and methotrexate (MTX) or azathioprine (AZA) is used as steroid-sparing second-line treatment, with conflicting results.

Ultrasonographic resolution of the vessel wall oedema with modest clinical improvement in a large-vessel vasculitis patient treated with tocilizumab

Tocilizumab seems to be an effective therapy with faster resolution of the vessel wall oedema determined by ultrasonography by suppressing Th17-cell activity, but the clinical improvement in the patient has been moderate and short-lived due to persistent Th1 cells activity.

Th17 and Th1 T-Cell Responses in Giant Cell Arteritis

Two pathogenic pathways mediated by Th17 and Th1 cells contribute to the systemic and vascular manifestations of GCA and targeting steroid-resistant Th1 responses will be necessary to resolve chronic smoldering vasculitis.