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Management of large-vessel vasculitis

Salvarani, Carloa; Hatemi, Gulenb

Current Opinion in Rheumatology: January 2019 - Volume 31 - Issue 1 - p 25–31
doi: 10.1097/BOR.0000000000000561
VASCULITIS SYNDROMES: Edited by Hasan Yazici and Yusuf Yazici

Purpose of review Glucocorticoids are the mainstay of therapy for large-vessel vasculitis, but potential toxicity and frequent relapses led to studies with nonbiologic and biologic glucocorticoid-sparing agents. The aim of this review is to discuss the recent evidence for the management of giant cell arteritis (GCA) and Takayasu arteritis (TAK).

Recent findings Tocilizumab proved to be a powerful glucocorticoid-sparing agent for GCA in a randomized placebo-controlled trial, whereas the trials with tocilizumab and abatacept failed to show a significant difference from placebo in relapse-free survival rate in TAK. Further trials are awaiting for establishing the role of abatacept and ustekinumab for GCA, and rituximab and tumor necrosis factor inhibitors, including certolizumab for TAK, as well as nonbiologic agents for both indications.

Summary Despite recent randomized controlled trials with biologic agents, management of large-vessel vasculitis largely depends on observational studies. Well designed controlled trials using validated outcome measures in large number of patients, identification of biologic markers that could guide the choice of targeted treatments, and standardization of disease assessment including imaging modalities are unmet needs for the management of large-vessel vasculitis.

aAzienda USL-IRCCS di Reggio Emilia, Università di Modena e Reggio Emilia, Modena, Italy

bDepartment of Internal Medicine, Division of Rheumatology, School of Medicine, Istanbul University – Cerrahpasa, Istanbul, Turkey

Correspondence to Carlo Salvarani, Azienda USL-IRCCS di Reggio Emilia, Università di Modena e Reggio Emilia, Modena, Italy. E-mail: carlo.salvarani@ausl.re.it

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