The effectiveness of tocilizumab and its comparison with tumor necrosis factor alpha inhibitors for Takayasu Arteritis: A systematic review and meta-analysis

Misra, Durga Prasanna; Singh, Kritika; Rathore, Upendra; Patro, Pallavi; Tomelleri, Alessandro; Campochiaro, Corrado; Agarwal, Vikas; Sharma, Aman

doi:10.1016/j.autrev.2023.103275

Cited by 21 publications

(15 citation statements)

References 56 publications

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“…Addition of JAK1 inhibitors tofacitinib and itacitinib to IL-6 and IL-6R in vitro reduced LC3-II expression (a marker of autophagy), autophagosome formation, and production of collagen 1 and fibronectin in the culture supernatant of AAF, mediated through STAT3 ( 42 ). These experiments identify potential mechanisms for the observed effectiveness of tocilizumab ( 12 ) and tofacitinib ( 11 ) in TAK.…”

Section: Aortic Adventitial Fibroblasts As Drivers Of Fibrosis In Takmentioning

confidence: 98%

Arterial wall fibrosis in Takayasu arteritis and its potential for therapeutic modulation

et al. 2023

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Arterial wall damage in Takayasu arteritis (TAK) can progress despite immunosuppressive therapy. Vascular fibrosis is more prominent in TAK than in giant cell arteritis (GCA). The inflamed arterial wall in TAK is infiltrated by M1 macrophages [which secrete interleukin-6 (IL-6)], which transition to M2 macrophages once the inflammation settles. M2 macrophages secrete transforming growth factor beta (TGF-β) and glycoprotein non-metastatic melanoma protein B (GPNMB), both of which can activate fibroblasts in the arterial wall adventitia. Mast cells in the arterial wall of TAK also activate resting adventitial fibroblasts. Th17 lymphocytes play a role in both TAK and GCA. Sub-populations of Th17 lymphocytes, Th17.1 lymphocytes [which secrete interferon gamma (IFN-γ) in addition to interleukin-17 (IL-17)] and programmed cell death 1 (PD1)-expressing Th17 (which secrete TGF-β), have been described in TAK but not in GCA. IL-6 and IL-17 also drive fibroblast activation in the arterial wall. The Th17 and Th1 lymphocytes in TAK demonstrate an activation of mammalian target organ of rapamycin 1 (mTORC1) driven by Notch-1 upregulation. A recent study reported that the enhanced liver fibrosis score (derived from serum hyaluronic acid, tissue inhibitor of metalloproteinase 1, and pro-collagen III amino-terminal pro-peptide) had a moderate-to-strong correlation with clinically assessed and angiographically assessed vascular damage. In vitro experiments suggest the potential to target arterial wall fibrosis in TAK with leflunomide, tofacitinib, baricitinib, or mTORC1 inhibitors. Since arterial wall inflammation is followed by fibrosis, a strategy of combining immunosuppressive agents with drugs that have an antifibrotic effect merits exploration in future clinical trials of TAK.

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Section: Aortic Adventitial Fibroblasts As Drivers Of Fibrosis In Takmentioning

confidence: 98%

Arterial wall fibrosis in Takayasu arteritis and its potential for therapeutic modulation

et al. 2023

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“…The reason why ACR prefers TNFis over TCZ is the presence of a negative RCT and the scarce literature on TCZ in TAK patients (7,8,49). However, in terms of efficacy, a recent meta-analysis, including six studies that directly compared TCZ with TNFis and were amenable to meta-analysis, reported a similar capacity of inducing remission (defined as clinical response and/or angiographic stabilisation) (57). Two multicentre retrospective cohorts involving 111 and 209 refractory TAK, respectively did not detect any differ-ences in terms of risk of relapse, GC dose decrease and drug retention rate (43,58).…”

Section: Pros and Cons Of Tnf Inhibitors Versus Tocilizumabmentioning

confidence: 99%

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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“…Эффективность ингибиторов ИЛ-6 в лечении АТ подтверждают и результаты наблюдательных исследований [29]. В самом крупном ретроспективном исследовании, в котором принимала участие и клиника им.…”

Section: аа-амилоидоз -редкая причина поражения почек у пациентки с а...unclassified

AA-amyloidosis as a rare cause of kidney disease in patient with Takayasu’s arteritis

Logina¹,

Bulanov²,

Kuznetsova³

et al. 2023

CPT

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Takayasu’s arteritis (TAK) is a systemic large vessel vasculitis that usually develops at young age in females and affects aorta and its branches (pulseless disease). Patients with TAK frequently present with renal artery stenosis associated with renovascular hypertension and ischemic nephropathy, whereas glomerular and interstitial kidney disease is very rare. As any other chronic inflammatory diseases, TAK can be complicated with AA-amyloidosis manifesting by progressive proteinuria, nephrotic syndrome and chronic renal failure. AA-amyloidosis in patients with TAK and other immune-mediated inflammatory disease justifies intensification of immunosuppressive and antiinflammatory therapy (e.g. using interleukin-6 inhibitors) that is essential to prevent progression of kidney amiloidosis.

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The effectiveness of tocilizumab and its comparison with tumor necrosis factor alpha inhibitors for Takayasu Arteritis: A systematic review and meta-analysis

Cited by 21 publications

References 56 publications

Arterial wall fibrosis in Takayasu arteritis and its potential for therapeutic modulation

Arterial wall fibrosis in Takayasu arteritis and its potential for therapeutic modulation

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

AA-amyloidosis as a rare cause of kidney disease in patient with Takayasu’s arteritis

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