Arterite de Takayasu: tratamento com anti-TNF em uma casuística brasileira

Nunes, Guilherme S.; Neves, Fabrício Souza; Melo, Felipe M; Castro, Gláucio Ricardo Werner de; Zimmermann, Adriana Fontes; Pereira, Ivânio Alves

doi:10.1590/s0482-50042010000300009

Cited by 26 publications

(2 citation statements)

References 14 publications

(19 reference statements)

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“…Unfortunately, there are no randomized controlled trials to specifically guide the treatment of TAK patients with organ- or life-threatening manifestations. However, historical observational studies suggest that TNFi and tocilizumab are more effective than nontargeted immunosuppressant for maintaining remission, sparing GC use, and preventing subclinical disease progression in patients with TAK in general 10,37,38,40–54 . In addition, although a randomized controlled trial comparing tocilizumab versus placebo did not meet its primary outcome in an intention-to-treat analysis, a per-protocol analysis showed a decreased risk of disease relapse associated with tocilizumab 55 .…”

Section: Resultsmentioning

confidence: 99%

“…However, historical observational studies suggest that TNFi and tocilizumab are more effective than nontargeted immunosuppressant for maintaining remission, sparing GC use, and preventing subclinical disease progression in patients with TAK in general. 10,37,38,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] In addition, although a randomized controlled trial comparing tocilizumab versus placebo did not meet its primary outcome in an intention-to-treat analysis, a per-protocol analysis showed a decreased risk of disease relapse associated with tocilizumab. 55 Acknowledging the limitations of the available evidence, we conditionally recommend therapy with TNFi or tocilizumab in combination with GCs over using GCs alone for patients presenting organor life-threatening disease.…”

Section: Resultsmentioning

confidence: 99%

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Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis

et al. 2023

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Objective To develop the first evidence-based Pan American League of Associations for Rheumatology (PANLAR) guidelines for the treatment of Takayasu arteritis (TAK). Methods A panel of vasculitis experts developed a series of clinically meaningful questions addressing the treatment of TAK patients in the PICO (population/intervention/comparator/outcome) format. A systematic literature review was performed by a team of methodologists. The evidence quality was assessed according to the GRADE (Grading of Recommendations/Assessment/Development/Evaluation) methodology. The panel of vasculitis experts voted each PICO question and made recommendations, which required ≥70% agreement among the voting members. Results Eleven recommendations were developed. Oral glucocorticoids are conditionally recommended for newly diagnosed and relapsing TAK patients. The addition of nontargeted synthetic immunosuppressants (e.g., methotrexate, leflunomide, azathioprine, or mycophenolate mofetil) is recommended for patients with newly diagnosed or relapsing disease that is not organ- or life-threatening. For organ- or life-threatening disease, we conditionally recommend tumor necrosis factor inhibitors (e.g., infliximab or adalimumab) or tocilizumab with consideration for short courses of cyclophosphamide as an alternative in case of restricted access to biologics. For patients relapsing despite nontargeted synthetic immunosuppressants, we conditionally recommend to switch from one nontargeted synthetic immunosuppressant to another or to add tumor necrosis factor inhibitors or tocilizumab. We conditionally recommend low-dose aspirin for patients with involvement of cranial or coronary arteries to prevent ischemic complications. We strongly recommend performing surgical vascular interventions during periods of remission whenever possible. Conclusion The first PANLAR treatment guidelines for TAK provide evidence-based guidance for the treatment of TAK patients in Latin American countries.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis

et al. 2023

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Tumor necrosis factor inhibitors in patients with Takayasu arteritis: Experience from a referral center with long‐term followup

Schmidt¹,

Kermani²,

Bacani³

et al. 2012

Arthritis Care & Research

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Objective. To report a single-center experience with the use of tumor necrosis factor (TNF) inhibitors in patients with Takayasu arteritis (TA). Methods. We retrospectively studied a cohort of patients with refractory TA evaluated at our institution and treated with TNF inhibitors. American College of Rheumatology criteria for TA were used for inclusion. Disease activity was assessed according to the National Institutes of Health criteria. months). Treatment with TNF inhibitors resulted in disease remission in 18 (90%) of 20 patients and sustained remission in 10 patients (50%). Ten (83%) of 12 patients were able to taper prednisone below 10 mg and 7 patients discontinued prednisone. However, 6 of the 18 patients achieving remission experienced relapse while receiving TNF inhibitors. Eleven patients (55%) discontinued TNF inhibitors for the following reasons: relapse, persistently active disease, lack of corticosteroid-sparing effect, adverse effects (4 patients), and other reasons (4 patients). Conclusion. In this study, treatment with TNF inhibitors induced remission, including sustained remission in patients with refractory TA. However, 33% of patients experienced disease relapse while receiving TNF inhibitors and 20% discontinued treatment because of adverse events.

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Effects of resistance exercise on treatment outcome and laboratory parameters of Takayasu arteritis with magnetic resonance imaging diagnosis: A randomized parallel controlled clinical trial

Liu

Wang

et al. 2020

Clinical Cardiology

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Background: Elevated tumor necrosis factor-α (TNF-α) is correlated with refractory Takayasu arteritis (TA), and resistance exercise have been shown to inhibit TNF-α. Hypothesis: We aimed to explore the effect of resistance exercise in the clinical management of TA. Methods: This clinical trial enrolled a total of 342 acute TA patients, who were subsequently randomized to undergo either resistance exercise or relaxation control twice per week for 12 weeks. The disease activity was defined using the primary outcome of Birmingham Vascular Activity Score (BVAS). Secondary outcomes included levels of plasma TNF-α and C-reactive protein (CRP), and the erythrocyte sedimentation rate (ESR). Results: BVAS scores along with other laboratory parameters obtained from the patients in the resistance exercise group showed a gradual decline throughout the course of the trial. By contrast, outcomes appeared largely unaltered in the relaxation control group patients. Analyses also revealed that plasma TNF-α displayed strong linear correlations with ESR, BVAS scores, and plasma CRP levels. Conclusion: Resistance exercise could substantially improve treatment outcomes as well as laboratory parameters in patients with acute TA, probably through decreasing TNF-α.

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Arterite de Takayasu: tratamento com anti-TNF em uma casuística brasileira

Abstract: Recebido em 29/09/2009. Aprovado, após revisão, em 06/04/2010. Declaramos a inexistência de conflitos de interesse.

Cited by 26 publications

References 14 publications

Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis

Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis

Tumor necrosis factor inhibitors in patients with Takayasu arteritis: Experience from a referral center with long‐term followup

Effects of resistance exercise on treatment outcome and laboratory parameters of Takayasu arteritis with magnetic resonance imaging diagnosis: A randomized parallel controlled clinical trial

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