Treatment of refractory temporal arteritis with adalimumab.
High-dose corticosteroids (CS) are the mainstay of treatment for temporal (giant cell) arteritis (TA). A usually required long-term treatment with CS, ranging from 1 to 5 years or more, frequently leads to serious side effects in about 60% of patients. There is no conclusive evidence about the role of immunosuppressive agents like methotrexate and azathioprine in the treatment of TA. There are few reports of treatment of refractory or steroid-dependent TA with tumor necrosis factor alpha (TNF-alpha) inhibitors including infliximab and etanercept. TA is characterized by infiltration of the vessel wall by macrophages, giant cells, and T lymphocytes, with production of several cytokines responsible for the acute phase response. TNF-alpha has been demonstrated in up to 60% of the cells in all areas of inflamed arteries by immunohistochemical techniques; hence, it could play a pivotal role in the pathogenesis of TA. We report the first case of resistant TA, which was treated successfully with adalimumab, a fully human recombinant IgG1, anti-TNF-alpha monoclonal antibody. The efficacy of TNF-alpha inhibitors in resistant TA should be studied in larger, controlled studies.
Ahmed
M Mubashir
MM
Louisiana State University Health Sciences Center, Division of Rheumatology, Department of Medicine, Center of Excellence for Arthritis and Rheumatology, 1501 Kings Highway, Shreveport, LA 71130, USA. Mahmed3@lsuhsc.edu
Mubashir
Eisha
E
Hayat
Samina
S
Fowler
Marjorie
M
Berney
Seth Mark
SM
D000068879:Adalimumab; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000494:pharmacology; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D004351:Drug Resistance; D005260:Female; D013700:Giant Cell Arteritis / Q000188:drug therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007155:Immunologic Factors; D000068879:Adalimumab