Reducing the Toxicity of Long-Term Glucocorticoid Treatment in Large Vessel Vasculitis

Palmowski, Andriko; Buttgereit, Frank

doi:10.1007/s11926-020-00961-0

Cited by 10 publications

(7 citation statements)

References 76 publications

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“…Glucocorticoid monotherapy in TAK generally leads to a good short-term clinical response, but most patients relapse upon GC tapering or discontinuation 10,11,25 . Unfortunately, long-term GC treatment causes toxicity in the majority of cases 26 . There are no randomized controlled trials assessing the efficacy and safety of different nontarget immunosuppressants either against placebo or in head-to-head comparisons in patients with TAK.…”

Section: Resultsmentioning

confidence: 99%

“…10,11,25 Unfortunately, long-term GC treatment causes toxicity in the majority of cases. 26 There are no randomized controlled trials assessing the efficacy and safety of different nontarget immunosuppressants either against placebo or in head-to-head comparisons in patients with TAK. However, very-low quality evidence from historical observational studies, mostly including relapsing or refractory patients, suggests that nontargeted immunosuppressants in combination with GCs may decrease the risk of disease relapse and the GC exposure when compared with GC monotherapy.…”

Section: Resultsmentioning

confidence: 99%

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Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis

et al. 2023

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Objective To develop the first evidence-based Pan American League of Associations for Rheumatology (PANLAR) guidelines for the treatment of Takayasu arteritis (TAK). Methods A panel of vasculitis experts developed a series of clinically meaningful questions addressing the treatment of TAK patients in the PICO (population/intervention/comparator/outcome) format. A systematic literature review was performed by a team of methodologists. The evidence quality was assessed according to the GRADE (Grading of Recommendations/Assessment/Development/Evaluation) methodology. The panel of vasculitis experts voted each PICO question and made recommendations, which required ≥70% agreement among the voting members. Results Eleven recommendations were developed. Oral glucocorticoids are conditionally recommended for newly diagnosed and relapsing TAK patients. The addition of nontargeted synthetic immunosuppressants (e.g., methotrexate, leflunomide, azathioprine, or mycophenolate mofetil) is recommended for patients with newly diagnosed or relapsing disease that is not organ- or life-threatening. For organ- or life-threatening disease, we conditionally recommend tumor necrosis factor inhibitors (e.g., infliximab or adalimumab) or tocilizumab with consideration for short courses of cyclophosphamide as an alternative in case of restricted access to biologics. For patients relapsing despite nontargeted synthetic immunosuppressants, we conditionally recommend to switch from one nontargeted synthetic immunosuppressant to another or to add tumor necrosis factor inhibitors or tocilizumab. We conditionally recommend low-dose aspirin for patients with involvement of cranial or coronary arteries to prevent ischemic complications. We strongly recommend performing surgical vascular interventions during periods of remission whenever possible. Conclusion The first PANLAR treatment guidelines for TAK provide evidence-based guidance for the treatment of TAK patients in Latin American countries.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis

et al. 2023

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“…Lastly, the risks of long-term corticosteroid therapy are important to consider in the management of these patients. Major risks such as cardiovascular complications, diabetes mellitus, avascular necrosis and osteoporosis are well established [ 26 ]. Consequently, we advocate in favor of the procedure if it may alter the long-term treatment of a patient.…”

Section: Discussionmentioning

confidence: 99%

Optimizing the use of temporal artery biopsy: A retrospective study

Villeneuve

Lacroix

Brisebois

2023

Journal of Otolaryngology - Head & Neck Surgery

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Background Giant cell arteritis is an inflammatory disease of the large- and medium-sized vessels. It is the most common primary vasculitis, with lifetime incidences of 0.5% and 1% in men and women, respectively. Its diagnosis is based upon clinical criteria, which may include temporal artery biopsy. Expected positivity rates of temporal artery biopsies and patient selection remain controversial topics in the literature. Methods A cross-sectional retrospective study of 127 patients referred for temporal artery biopsy with a diagnosis of suspected giant cell arteritis between January 2014 and December 2018 was performed. The primary outcome was the positivity rate. The relationships between positivity rates, symptoms, clinical suspicion, biopsy delay, biopsy length and corticosteroid treatment were also studied. Results A positivity rate of 23.7% (16.6–32.6%) was shown, along with a significant association between jaw claudication and specimen positivity (odds ratio 8.1, p < 0.05). Moreover, there were significant associations between a high initial clinical suspicion of disease and specimen positivity (p < 0.05), as well as a high initial clinical suspicion of disease and pursuit of corticosteroid treatment following biopsy results, regardless of positivity (p < 0.05). The duration of corticosteroid treatment prior to biopsy was not associated with a change in positivity rate. Conclusions The positivity rate of temporal artery biopsy was 23.7%. Treatment of patients with negative temporal artery biopsy was associated with maintenance of corticosteroid treatment when the initial clinical suspicion of arteritis was high. Therefore, temporal artery biopsy may not be necessary for patients with a high initial clinical suspicion of giant cell arteritis. Graphical Abstract

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“…It was first described by Mikita Takayasu” 2 . When treating Takayasu, systemic glucocorticoids are typically the first line of treatment 3,4 . However, most patients either do not achieve remission with glucocorticoids or relapse occurs while taking glucocorticoids.…”

Section: Introductionmentioning

confidence: 99%

Azathioprine‐induced lymphoma in a patient with Takayasu arteritis: A case report from Iraq

Awadh,

Al‐Osami,

Hashim

et al. 2023

Clinical Case Reports

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Reducing the Toxicity of Long-Term Glucocorticoid Treatment in Large Vessel Vasculitis

Cited by 10 publications

References 76 publications

Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis

Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis

Optimizing the use of temporal artery biopsy: A retrospective study

Azathioprine‐induced lymphoma in a patient with Takayasu arteritis: A case report from Iraq

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