Anti-tumor necrosis factor therapy in patients with refractory Takayasu’s arteritis: long-term follow-up
Eamonn S Molloy 1*, Carol A Langford 1, Tiffany M Clark 1, Carmen E Gota 1 and Gary S Hoffman 1
1 Cleveland Clinic, United States
* To whom correspondence should be addressed. E-mail: eamonn.molloy{at}ireland.com.
Accepted 26 July 2008
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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.
