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Refractory Takayasu arteritis successfully treated with rituximab: case-based review


Takayasu arteritis (TAK) is a subtype of the large-vessel vasculitis, affecting the aorta and its major branches. Although T cell-mediated autoimmunity is mainly involved in vascular inflammation, in recent years, accumulating evidence suggests the important role of B cells in the pathogenesis and effectiveness of B-cell-targeted therapy with rituximab (RTX), a chimeric anti-CD20 monoclonal antibody in refractory TAK. Herein, we report for the first time a case involving a 34-year-old man with TAK who was refractory to four different biologic agents, such as one selective T-cell co-stimulation modulator (abatacept), one anti-interleukin-6 receptor monoclonal antibody (tocilizumab), and two tumor necrosis factor-α inhibitors (infliximab and etanercept), but eventually achieved remission with RTX. He received a total of six courses of RTX, and doses of prednisolone and methotrexate were tapered without relapse. The current case provided further evidence to the potential role of RTX therapy in patients with refractory TAK, and its efficacy needs to be validated in a controlled trial.

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Authors and Affiliations



TM provided patient’s management, performed the literature review, and wrote the manuscript; TI, KA, YF, YS, and HF were involved in the clinical management; TI, TS, YK, HS, and HH provided intellectual contributions; TI supervised the entire process from drafting the paper to submission of the final manuscript.

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Correspondence to Tomonori Ishii.

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Written informed consent was obtained from this patient.

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Mutoh, T., Ishii, T., Shirai, T. et al. Refractory Takayasu arteritis successfully treated with rituximab: case-based review. Rheumatol Int 39, 1989–1994 (2019).

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  • Takayasu arteritis
  • Large-vessel vasculitis
  • Rituximab
  • B cells