Standard and biological treatment in large vessel vasculitis: guidelines and current approaches

Francesco Muratore, Nicolò Pipitone, Carlo Salvarani

Research output: Contribution to journalReview article

Abstract

Introduction: Giant cell arteritis and Takayasu arteritis are the two major forms of idiopathic large vessel vasculitis. High doses of glucocorticoids are effective in inducing remission in both conditions, but relapses and recurrences are common, requiring prolonged glucocorticoid treatment with the risk of the related adverse events. Areas covered: In this article, we will review the standard and biological treatment strategies in large vessel vasculitis, and we will focus on the current approaches to these diseases. Expert commentary: The results of treatment trials with conventional immunosuppressive agents such as methotrexate, azathioprine, mycophenolate mofetil, and cyclophosphamide have overall been disappointing. TNF-α blockers are ineffective in giant cell arteritis, while observational evidence and a phase 2 randomized trial support the use of tocilizumab in relapsing giant cell arteritis. Observational evidence strongly supports the use of anti-TNF-α agents and tocilizumab in Takayasu patients with relapsing disease. However biological agents are not curative, and relapses remain common.

Original languageEnglish
Pages (from-to)345-360
Number of pages16
JournalExpert Review of Clinical Immunology
Volume13
Issue number4
DOIs
Publication statusPublished - Apr 3 2017

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Keywords

  • anti-TNF-α
  • biological agents
  • giant cell arteritis
  • immunosuppressive agents
  • Large vessel vasculitis
  • Takayasu arteritis
  • tocilizumab
  • treatment

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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