title: Standard and biological treatment in large vessel vasculitis: guidelines and current approaches.
abstract: Giant cell arteritis and Takayasu arteritis are the two major forms of idiopathic large vessel vasculitis. High doses of glucocorticoids are effective in inducing remission in both conditions, but relapses and recurrences are common, requiring prolonged glucocorticoid treatment with the risk of the related adverse events. Areas covered: In this article, we will review the standard and biological treatment strategies in large vessel vasculitis, and we will focus on the current approaches to these diseases. Expert commentary: The results of treatment trials with conventional immunosuppressive agents such as methotrexate, azathioprine, mycophenolate mofetil, and cyclophosphamide have overall been disappointing. TNF-α blockers are ineffective in giant cell arteritis, while observational evidence and a phase 2 randomized trial support the use of tocilizumab in relapsing giant cell arteritis. Observational evidence strongly supports the use of anti-TNF-α agents and tocilizumab in Takayasu patients with relapsing disease. However biological agents are not curative, and relapses remain common.
authors.affiliation: a Rheumatology Unit, Department of Internal Medicine , Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico , Reggio Emilia , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Muratore
authors.affiliation: a Rheumatology Unit, Department of Internal Medicine , Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico , Reggio Emilia , Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Pipitone
authors.affiliation: a Rheumatology Unit, Department of Internal Medicine , Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico , Reggio Emilia , Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Salvarani
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D001691:Biological Therapy / Q000639:trends*; D002986:Clinical Trials as Topic; D013700:Giant Cell Arteritis / Q000628:therapy*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008233:Lymphotoxin-alpha / Q000276:immunology; D008727:Methotrexate / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012074:Remission Induction; D013625:Takayasu Arteritis / Q000628:therapy*
chemical_list: D000911:Antibodies, Monoclonal; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D008233:Lymphotoxin-alpha; D001379:Azathioprine; D008727:Methotrexate
keywords: Large vessel vasculitis; Takayasu arteritis; anti-TNF-α; biological agents; giant cell arteritis; immunosuppressive agents; tocilizumab; treatment