Anti-tumor necrosis factor therapy in patients with refractory Takayasu's arteritis: long-term follow-up.

Author(s): Molloy ES, Langford CA, Clark TM, Gota CE, Hoffman GS

Affiliation(s): Cleveland Clinic, United States.

Publication date & source: 2008-08-03, Ann Rheum Dis., [Epub ahead of print]

Publication type:

OBJECTIVE: Assess the efficacy of anti-tumor necrosis factor (TNF) therapy to induce remission in patients with Takayasu's arteritis (TAK) refractory to other immunosuppressive therapies. METHODS: Retrospective single-center study of 25 patients with refractory TAK. RESULTS: Patients were treated with infliximab (IFX) or etanercept (ETA) for up to 7 years; 21 with IFX [median 28 (range 2-84) months] and 9 with ETA [median 28 (range 4-82) months]; 5 patients initially treated with ETA subsequently switched to IFX. Following anti-TNF therapy, remission was achieved and prednisone was discontinued in 15 patients (60%) and successfully tapered below 10mg per day in an additional 7 patients (28%). Of 18 patients treated with other immunosuppressive agents concurrent with anti-TNF therapy, 9 (50%) could taper or discontinue the additional agent. Major relapses occurred in 4 patients that initially achieved stable remission. Four patients suffered adverse events, including 1 with opportunistic infections and 1 with breast cancer. CONCLUSIONS: In this group of patients with refractory TAK, anti-TNF therapy was associated with remission in a majority of patients, facilitating dose reduction or discontinuation of prednisone and other immunosuppressive therapy. These findings strengthen the rationale for the conduct of a randomized controlled trial of anti-TNF therapy in TAK.