Takayasu's arteritis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]

Overview

Most people with Takayasu’s arteritis respond to steroids such as prednisone. The usual starting dose is approximately 1 milligram per kilogram of body weight per day (for most people, this is approximately 60 milligrams a day). The two most important aspects of treatment: are controlling the inflammatory process and controlling hypertension.

Medical Therapy

Medical therapy of Takayasu arteritis depends on the disease activity and the complications that develop.

The two most important aspects of treatment:

• Controlling the inflammatory process
• Controlling hypertension

Corticosteroids

• Corticosteroids are the mainstay of therapy for active Takayasu arteritis

• Most people with Takayasu’s arteritis respond to steroids such as prednisone

• The usual starting dose is approximately 1 milligram per kilogram of body weight per day
• Long-term, low-dose corticosteroid therapy may be required
• Osteoporosis prevention when patients are started on corticosteroids should be considered

IL-6 receptor inhibitor

• Humanized monoclonal antibody tocilizumab suggested as a treatment for Takayasu arteritis through blockade of the soluble interleukin-6 (IL-6) receptor.

B-cell depletion

• B cells are believed to have an antibody-independent effect, which may modulate regulatory T-cell immune reactions against foreign and self-antigens.

• Rituximab is an example of B-cell depletion that has been shown to improve clinical signs and symptoms of Takayasu arteritis.

Cytotoxic agents

• Methotrexate, azathioprine, and cyclophosphamide are

• Used for patients whose disease is steroid resistant or relapsing
• Continued for at least 1 year after remission and are then tapered to discontinuation