title: Effects of immunosuppressive and biological agents on refractory Takayasu arteritis patients unresponsive to glucocorticoid treatment.
abstract: We aimed to investigate the effects of immunosuppressive and biological agents on refractory Takayasu arteritis (TA) patients resistant to or dependent on glucocorticoids.
  
  
  
  Forty-four consecutive TA patients were enrolled, and the clinical characteristics and effectiveness of the immunosuppressive and biological agents in achieving and maintaining remission among glucocorticoid-resistant or glucocorticoid-dependent patients were investigated.
  
  
  
  Fifteen patients showed favorable response to the initial glucocorticoid treatment, and 29 patients exhibited resistance to initial glucocorticoid treatment or relapsed with tapering glucocorticoid. Of the 29 patients, 5 responded to additional glucocorticoid treatment, and 22 of the remaining 24 glucocorticoid-resistant or glucocorticoid-dependent patients were prescribed immunosuppressive agents. Methotrexate was the most commonly used in these patients as the first-line treatment. In total, 10 patients maintained remission using immunosuppressive agents, with the effectiveness of each agent about 20%. The only significant difference between patients who were and were not able to achieve and maintain remission with immunosuppressive agents was the presence of the HLA-B52 allele (p<0.0001). Biological agents were administered to 6 patients refractory to immunosuppressive agents. All patients were administered tumor necrosis factor (TNF) inhibitors as the first-line treatment, and 3 patients maintained remission. Anti-interleukin-6 receptor antibody was administered to 2 patients who were resistant to the TNF inhibitors, and 1 patient achieved and maintained remission.
  
  
  
  In our cohort, 64% of the glucocorticoid-resistant or glucocorticoid-dependent patients maintained remission through a combined treatment with glucocorticoid, immunosuppressive agents, and/or biological agents. The combined use of immunosuppressive and biological agents appears to be a promising treatment option for achieving and maintaining remission in refractory TA patients.
authors: Department of Cardiovascular Medicine, Kashiwa City Hospital, Chiba, Japan. Electronic address: hohigashi.cvm@tmd.ac.jp.
authors: Hirokazu
authors: H
authors: Ohigashi
authors: Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors: Natsuko
authors: N
authors: Tamura
authors: Bioethics Research Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors: Yusuke
authors: Y
authors: Ebana
authors: Department of Pharmacovigilance, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors: Masayoshi
authors: M
authors: Harigai
authors: Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors: Yasuhiro
authors: Y
authors: Maejima
authors: Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors: Takashi
authors: T
authors: Ashikaga
authors: Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors: Mitsuaki
authors: M
authors: Isobe
mesh_terms: D000328:Adult; D000483:Alleles; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D059950:HLA-B52 Antigen / Q000235:genetics; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D012074:Remission Induction; D012189:Retrospective Studies; D013625:Takayasu Arteritis / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D059950:HLA-B52 Antigen; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D011239:Prednisolone; D000069285:Infliximab; C502936:tocilizumab; D000068800:Etanercept
keywords: Biological agent; Immunosuppressive agents; Relapse; Takayasu arteritis