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Current and Future Treatment Options for Takayasu Arteritis and Persistent Therapeutic Challenges

  • Vasculitis (C Pagnoux and M Walsh, Section Editors)
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Opinion statement

Takayasu arteritis is a large vessel vasculitis of unknown aetiology, more common in the tropics. Assessment of disease activity is challenging and evolving, with limitations in the use of conventional inflammatory markers like ESR and CRP resulting in utilization of composite clinical (Kerr criteria, ITAS2010) and imaging (angiography and FDG-PET) modalities. Management is challenging, with a paucity of high-quality evidence to guide therapy. Conventional disease-modifying agents are commonly used, although evidence base is limited, with methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide and leflunomide showing efficacy in open label studies. Role of biologic agents like anti-TNF-alpha agents, tocilizumab and rituximab is based on open label evidence, with a recent randomized trial failing to show significant efficacy of abatacept in reducing disease relapses. Endovascular stenting and open surgical revascularisation, generally done when disease is inactive, help in restoration of blood flow supplied by stenosed segments; however, these may require to be repeated as restenosis is not rare.

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Authors and Affiliations

  1. Clinical Immunology and Rheumatology wing, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India

    GSRSNK Naidu MD & Aman Sharma MD

  2. Sanjay Gandhi Post Graduate Institute, Lucknow, India

    Durga Prasanna Misra DM

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Naidu, G., Misra, D.P. & Sharma, A. Current and Future Treatment Options for Takayasu Arteritis and Persistent Therapeutic Challenges. Curr Treat Options in Rheum 3, 141–152 (2017). https://doi.org/10.1007/s40674-017-0070-2

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