Management of Takayasu arteritis: A systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

Ana F. Agueda, Sara Monti, Raashid Ahmed Luqmani, Frank Buttgereit, Maria Cid, Bhaskar Dasgupta, Christian Dejaco, Alfred Mahr, Cristina Ponte, Carlo Salvarani, Wolfgang Schmidt, Bernhard Hellmich

Research output: Contribution to journalArticlepeer-review

Abstract

Objective To collect available evidence on management of large vessel vasculitis to inform the 2018 update of the EULAR management recommendations. Methods Two independent systematic literature reviews were performed, one on diagnosis and monitoring and the other on drugs and surgical treatments. Using a predefined PICO (population, intervention, comparator and outcome) strategy, Medline, Embase and Cochrane databases were accessed. Eligible papers were reviewed and results condensed into a summary of findings table. This paper reports the main results for Takayasu arteritis (TAK). Results A total of 287 articles were selected. Relevant heterogeneity precluded meta-analysis. Males appear to have more complications than females. The presence of major complications, older age, a progressive disease course and a weaker inflammatory response are associated with a more unfavourable prognosis. Evidence for details on the best disease monitoring scheme was not found. High-quality evidence to guide the treatment of TAK was not found. Glucocorticoids are widely accepted as first-line treatment. Conventional immunosuppressive drugs and tumour necrosis factor inhibitors were beneficial in case series and uncontrolled studies. Tocilizumab failed the primary endpoint (time to relapse) in a randomised controlled clinical trial; however, results still favoured tocilizumab over placebo. Vascular procedures may be required, and outcome is better when performed during inactive disease. Conclusions Evidence to guide monitoring and treatment of patients with TAK is predominantly derived from observational studies with low level of evidence. Therefore, higher-quality studies are needed in the future.

Original languageEnglish
Article numbere001020
JournalRMD Open
Volume5
Issue number2
DOIs
Publication statusPublished - Sep 1 2019

Keywords

  • Giant Cell Arteritis
  • Systemic vasculitis
  • Treatment

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

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