Insufficient Use of Corticosteroids without Immunosuppressants Results in Higher Relapse Rates in Takayasu Arteritis

Abstract

Objective.Although prednisolone (PSL) and immunosuppressants are key drugs for Takayasu arteritis (TA) treatment, there is limited evidence on the optimal PSL dose. The aim of this study was to investigate the correlation between the initial PSL dose and relapse in TA.Methods.We enrolled 105 patients with TA who satisfied the criteria of the Japanese Circulation Society and American College of Rheumatology from 1990 to 2015. The clinical characteristics and outcomes of patients with TA were retrospectively evaluated. The relapse-free period was assessed according to the difference in initial treatments.Results.Relapse was observed in 57 (59.4%) of 96 patients treated with immunosuppressive therapy at diagnosis during a median followup of 56 months. Male sex and younger age of onset were significantly associated with relapse. Although ≤ 30 mg/day PSL monotherapy was preferably prescribed for patients with lower inflammatory markers, compared with > 30 mg/day (87.2% vs 52.6%), a significantly higher relapse rate was observed in the ≤ 30 mg/day group (HR 1.78; p = 0.047). Further, the relapse-free period was longer in patients treated with ≥ 50 mg/day PSL compared with those treated with ≤ 40 mg/day PSL. Combination therapy improved the relapse-free period compared with PSL monotherapy in the short term. The initial PSL dose was not associated with adverse events.Conclusion.A higher dose of PSL was associated with a significant decrease in the relapse rate. The effect of combination therapy on relapse needs to be further investigated. Lower-dose PSL monotherapy is an undesirable strategy for remission induction in TA, despite low disease activity.

Migratory Aortitis Associated with Granulocyte-colony-stimulating Factor

“…Only 9 of the 21 cases were treated with steroids. Nevertheless, all cases improved without developing chronic aortitis, such as TAK (12). Since steroids were used in most of the cases reported, this is the first detailed report describing the natural course of aortitis induced by repeated G-CSF use.…”

Identification of two major autoantigens negatively regulating endothelial activation in Takayasu arteritis

“…One of the greatest issues in clinical practice is the absence of disease-specific testing for TAK 22 . Relapse is frequent, which accounts for approximately 60% of patients 23 . Although inflammatory markers and imaging studies are now used for TAK diagnosis and management, interpretation of these results is sometimes difficult because of their non-specificity.…”

Takayasu arteritis: a cohort of Italian patients and recent pathogenetic and therapeutic advances

“…Encouraging results in terms of a higher remission rate and rapid control of refractory disease have been reported in 40-60% of TAK patients [8,67]. Nonetheless, the benefit among those treated with GC was not sustained when the dose was ≤ 30 mg/day, even in patients with low disease activity [69], and vascular progression developed in at least one-third of the patients treated with biological drugs, either during treatment or after drug withdrawal [61,63,70]. In our own, thus far limited experience, 2 patients treated with GC plus MTX plus adalimumab achieved a transient clinical response, but their disease relapsed a few months after the discontinuation of adalimumab, despite continued treatment with a low dose of GC and a maintenance dose of MTX of 10 mg/week.…”