Comparing treatment options for large vessel vasculitis

Macaluso, Federica; Marvisi, Chiara; Castrignanò, Paola; Pipitone, Nicolò; Salvarani, Carlo

doi:10.1080/1744666x.2022.2092098

Cited by 10 publications

(8 citation statements)

References 98 publications

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“…For example, TNFi inhibitors showed a better therapeutic effect for TAK than that for GCA. [ 46 , 47 , 48 , 49 ] Inhibition of Th17 by using ustekinmab is being actively studied in TAK (NCT04882072). Anakinra (the recombinant IL-1Ra) was tried and showed effective in treatment of refractory GCA [ 50 ] but IL-1 blockade has not been tried in TAK.…”

Section: Arteritis-prone Mouse Models For Modification To Produce Lvv...mentioning

confidence: 99%

Animal models for large vessel vasculitis – The unmet need

Chu

2023

Rheumatology and Immunology Research

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Our understanding of the pathogenesis of large vessel vasculitis (LVV) are mainly achieved by studying the arteries taken from temporal artery biopsy in giant cell arteries (GCA) or surgical or autopsy specimens in Takayasu arteritis (TAK). These artery specimens provide invaluable information about pathological changes in these conditions that GCA and TAK are similar but are distinctly different in immune cell infiltrate and distribution of inflammatory cells in anatomical locations. However, these specimens of established arteritis do not provide information of the arteritis initiation and early events which are impossible to obtain in human artery specimens. Animal models for LVV are needed but not available. Here, several approaches are proposed for experimentation to generate animal models to aid in delineating the interaction of immune reaction with arterial wall components.

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Section: Arteritis-prone Mouse Models For Modification To Produce Lvv...mentioning

confidence: 99%

Animal models for large vessel vasculitis – The unmet need

Chu

2023

Rheumatology and Immunology Research

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“…There is no high quality evidence comparing GC tapering schedules to guide practice. [ 26 ] The cumulative amount of GC is directly associated with an increased risk of serious GC-related adverse effects [ 27 , 28 , 29 ] which result in increased health care costs. [ 30 ] Improving benefit-risk ratio to mitigate GC-related adverse effects continues to be a challenge.…”

Section: Advancement In Management Of Gcamentioning

confidence: 99%

Advances and challenges in management of large vessel vasculitis

Chu

2023

Rheumatology and Immunology Research

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Absract Glucocorticoids (GC) remains the mainstay for management of large vessel vasculitis (LVV). Recent introduction of interleukin-6 signaling blocker, tocilizumab has substantially changed the practice in management of patients with LVV, in particular, giant cell arteritis (GCA). Benefit of tocilizumab to patients with Takayasu arteritis (TAK) is supported by observational studies, but randomized clinical trials are lacking. Addition of tocilizumab enables reduction of the total amount of GC in patients with GCA, but GC burden remains high and to be further reduced. Ongoing studies aim at minimal use of GC or even GC-free. Tumor necrosis factor inhibitors appear to be beneficial to TAK despite their ineffectiveness to GCA. Randomized clinical trials are undergoing to target other inflammatory cytokines in both GCA and TAK. Janus kinase inhibitors alone or in combination with conventional disease modifying anti-rheumatic drugs showed promising results in treatment of TAK.

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“…Furthermore, there are some data on the association between elevated tissue TNF-α concentrations and disease activity (15). Three RCTs and a few other observational studies have investigated the use of TNFis in GCA, with negative or non-conclusive results (14,17), whereas some case series reported efficacy of TNFis (18,19). The first RCT was designed to evaluate the role of infliximab in maintaining remission in GCA (20).…”

Section: Tnf Inhibitors In Gcamentioning

confidence: 99%

“…In the most recent EULAR guidelines for the management of GCA, TCZ is considered as an adjunctive therapy to GCs in selected cases, such as patients at increased risk of developing GCrelated side effects or complications, or for relapsing or refractory disease requiring long-term GC therapy (7); whereas in the ACR guidelines, TCZ with GCs is considered as a first-line therapy in all patients (8). Although there is no clear evidence that TCZ is able to reduce GC-related side effects, particularly in the subgroup of patients without increased risk factors, early initiation of TCZ could represent a reasonable option in all new GCA patients (14). Indeed, TCZ has proven a powerful steroid sparing effect, much higher than that of methotrexate.…”

Section: Pros and Cons Of Tnf Inhibitors Versus Tocilizumabmentioning

confidence: 99%

“…Furthermore, long-term courses of GCs are associated with significant side effects, and recently attention has been raised to save GCs to decrease their potential harmful toxicity. Consequently, biologic therapy is becoming a firstline treatment, particularly in relapsing forms of GCA and TAK (5,7,8,(10)(11)(12)(13)(14). This review aims to give an overview of the pros and cons of tumour necrosis factor α inhibitors (TNFis) and tocilizumab (TCZ) in GCA and TAK, evaluating all the different aspects of these diseases in terms of outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Pros and cons of TNF inhibitors and tocilizumab in the treatment of large vessel vasculitis

Marvisi

Ricordi

Galli

et al. 2023

Clinical and Experimental Rheumatology

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Large-vessel vasculitides (LVVs) include giant cell arteritis (GCA) and Takayasu's arteritis (TAK). Even if similar, these two entities differ in terms of treatment and outcomes. High doses of glucocorticoids (GCs) are still the first choice for the treatment of both conditions. However, adjunctive therapies are recommended in selected patients in order to decrease the risk of relapse and the amount of side effects related to GCs. Tumour necrosis factor α inhibitors (TNFis) and tocilizumab (TCZ) are used for the treatment of LVVs, with some differences. In GCA, TCZ has been proved to be effective and safe in inducing remission with some open questions still remaining, whereas data about TNFis are scarce and nonconclusive. On the contrary, in TAK either TNFis or TCZ seem to be able to control symptoms and angiographic progression in refractory forms. However, their place in the management of treatment must still be clarified, and as a result the American College of Rheumatology and EULAR guidelines slightly differ in the recommendations about when and what treatment to start. Thus, the aim of this review is to look at the evidence on the use of TNFis and TCZ in LVVs, outlining the pros and cons of both therapies.

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Comparing treatment options for large vessel vasculitis

Cited by 10 publications

References 98 publications

Animal models for large vessel vasculitis – The unmet need

Animal models for large vessel vasculitis – The unmet need

Advances and challenges in management of large vessel vasculitis

Pros and cons of TNF inhibitors and tocilizumab in the treatment of large vessel vasculitis

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