Leflunomida na arterite de Takayasu – Estudo observacional de longo prazo

Souza, Alexandre Wagner Silva de; Agustinelli, Renan de Almeida; Almeida, Hemerli de Cinque; Oliveira, Patrícia Bermudes; Pinheiro, Frederico Augusto Gurgel; Oliveira, Ana Cecília Diniz; Sato, Emília Inoue

doi:10.1016/j.rbr.2015.09.007

Cited by 42 publications

(6 citation statements)

References 13 publications

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“…The median time to prednisolone withdrawal was 20.8 months for leflunomide and 34.1 for other DMARDs. Mean cumulative prednisolone dose was higher in other DMARD-treated patients (13.3 g) compared to leflunomide (6.3 g) [57]. [93].…”

Section: Studies Comparing Dmardsmentioning

confidence: 81%

“…Leflunomide Six observational studies (and a seventh study, a longer-term follow-up of one of the previous ones) assessed leflunomide in TAK [42,57,82,83,93,94,99]. For the three uncontrolled observational studies, the pooled proportion of patients achieving at least a partial clinical response was 80% (95% CI 70-89%, 3 studies, 73 patients, I 2 not assessable, Fig.…”

Section: Conventional Dmardsmentioning

confidence: 99%

“…The four studies comparing leflunomide with other DMARDs [57,83,93,94] shall be subsequently discussed.…”

Section: Conventional Dmardsmentioning

confidence: 99%

“…Leflunomide with other DMARDs A longer-term follow up [57] (for 43 ± 7.6 months) of an uncontrolled observational study on leflunomide in TAK previously discussed [42] compared 5 patients from the original cohort who continued leflunomide with seven others who were changed to other DMARDs (infliximab, adalimumab or azathioprine) during this time period. Similar proportions of angiographic stabilization were observed (risk ratio for leflunomide versus other DMARDs 1.4, 95% CI 0.88-2.24).…”

Section: Studies Comparing Dmardsmentioning

confidence: 99%

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Disease-modifying anti-rheumatic drugs for the management of Takayasu arteritis—a systematic review and meta-analysis

et al. 2021

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The pharmacotherapy of Takayasu arteritis (TAK) with disease-modifying anti-rheumatic drugs (DMARDs) is an evolving area. A systematic review of Scopus, Web of Science, Pubmed Central, clinical trial databases and recent international rheumatology conferences for interventional and observational studies reporting the effectiveness of DMARDs in TAK identified four randomized controlled trials (RCTs, with another longer-term follow-up of one RCT) and 63 observational studies. The identified trials had some concern or high risk of bias. Most observational studies were downgraded on the Newcastle-Ottawa scale due to lack of appropriate comparator groups. Studies used heterogenous outcomes of clinical responses, angiographic stabilization, normalization of inflammatory markers, reduction in vascular uptake on positron emission tomography, reduction in prednisolone doses and relapses. Tocilizumab showed benefit in a RCT compared to placebo in a secondary per-protocol analysis but not the primary intention-to-treat analysis. Abatacept failed to demonstrate benefit compared to placebo for preventing relapses in another RCT. Pooled data from uncontrolled observational studies demonstrated beneficial clinical responses and angiographic stabilization in nearly 80% patients treated with tumour necrosis factor alpha inhibitors, tocilizumab or leflunomide. Certainty of evidence for outcomes from RCTs ranged from moderate to very low and was low to very low for all observational studies. There is a paucity of high-quality evidence to guide the pharmacotherapy of TAK. Future observational studies should attempt to include appropriate comparator arms. Multicentric, adequately powered RCTs assessing both clinical and angiographic responses are necessary in TAK. Supplementary Information The online version contains supplementary material available at 10.1007/s10067-021-05743-2.

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Section: Studies Comparing Dmardsmentioning

confidence: 81%

Section: Conventional Dmardsmentioning

confidence: 99%

“…The four studies comparing leflunomide with other DMARDs [57,83,93,94] shall be subsequently discussed.…”

Section: Conventional Dmardsmentioning

confidence: 99%

Section: Studies Comparing Dmardsmentioning

confidence: 99%

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Disease-modifying anti-rheumatic drugs for the management of Takayasu arteritis—a systematic review and meta-analysis

et al. 2021

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“…Im Rahmen einer kleinen, nicht kontrollierten Studie wurde der Einsatz einer Sequenz aus einer 3-monatigen oralen Cyclophosphamid-Therapie gefolgt von einer Erhaltungstherapie mit wöchentlichem MTX untersucht [80]; für die Auswertung konnten 8 Fälle herangezogen werden, davon hatten 4 (50 %) eine anhaltende Remission. Die Kurzund Langzeitdaten einer weiteren kleinen prospektiven Fallserie (n = 15 Fälle) beschrieben eine hohe Remissionsrate (93 %), einen rezidivprophylaktischen und GC-einsparenden Effekt und eine akzeptable Verträglichkeit von Leflunomid 20 mg/Tag bei etwa 50 % der hiermit behandelten an TAK Erkrankten [248,250].…”

Section: Konventionelle Immunsuppressivaunclassified

S2k-Leitlinie: Management der Großgefäßvaskulitiden

Schirmer

Aries²,

Balzer

et al. 2020

Z Rheumatol

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Comparative Efficacy of Secukinumab Versus Tumor Necrosis Factor Inhibitors for the Treatment of Takayasu Arteritis

Tian

Jiang

et al. 2023

Arthritis & Rheumatology

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Objective Tumor necrosis factor (TNF) alpha and interleukin‐17 (IL‐17) are thought to be involved in the pathogenesis of Takayasu arteritis (TAK), and TNF inhibitors (TNFi) are recommended for the treatment of TAK. The present study was undertaken to investigate the efficacy of secukinumab, an IL‐17A monoclonal antibody, compared to treatment with TNFi. Methods This was a prospective, single‐center, open‐label cohort study. Patients with active TAK who did not respond to treatment with glucocorticoids combined with 2 immunosuppressive agents were treated with either secukinumab or TNFi as an add‐on therapy without an increased dosage of glucocorticoids. A complete response was defined as complete resolution of signs and symptoms of active disease, normal values of inflammatory markers, no progression on imaging of involved arteries, and dose of glucocorticoid <15 mg/day. A partial response was similarly defined as a complete response except with an erythrocyte sedimentation rate <40 mm/hour and C‐reactive protein level of <20 mg/liter. Results Nineteen patients in the secukinumab group and 34 patients in the TNFi group were enrolled. The demographic data and inflammatory markers of the 2 groups were comparable at baseline. Complete response and partial response for patients treated with secukinumab and TNFi were 31.6% and 58.8% (P = 0.057), respectively, at 3 months and 52.6% and 64.7%, respectively, at 6 months (P = 0.389). Conclusion Our findings suggest that secukinumab and TNFi are effective for patients with TAK who do not respond to oral glucocorticoids and conventional immunosuppressive agents, with similar response rates at 3 and 6 months.

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Leflunomida na arterite de Takayasu – Estudo observacional de longo prazo

Abstract: Leflunomide led to sustained remission in approximately half of patients at a mean time of 12 months and was well tolerated by TA patients.

Cited by 42 publications

References 13 publications

Disease-modifying anti-rheumatic drugs for the management of Takayasu arteritis—a systematic review and meta-analysis

Disease-modifying anti-rheumatic drugs for the management of Takayasu arteritis—a systematic review and meta-analysis

S2k-Leitlinie: Management der Großgefäßvaskulitiden

Comparative Efficacy of Secukinumab Versus Tumor Necrosis Factor Inhibitors for the Treatment of Takayasu Arteritis

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