ANTI-TUMOR NECROSIS FACTOR ALPHA THERAPY IS BENEFICAL FOR REFRACTORY TAKAYASU ARTERITIS: A MULTICENTRIC RETROSPECTIVE STUDY FROM TURKEY

Background: Takayasu arteritis (TA) is an idiopathic systemic granulomatous vasculitis of large and medium-sized vessels. Mainstay of treatment is to control the vessel inflammation and corticosteroids (CS) serve as the first line therapy for active TA. In case of inadequate response to CS treatment and/or severe side effects, conventional immunosuppressive (IS) agents such as methotrexate are usually required. Furthermore, anti-tumor necrosis factor (anti-TNF) therapy may also be considered in cases refractory to conventional IS agents. Objectives: We aimed to retrospectively analyze the efficacy of anti-TNF therapy in those patients with TA refractory to conventional IS agents. Methods: The data of 19 TA patients (F/M 13/6; mean age 34±10.1 (21-55) years; mean disease duration 7.9±5.0 years) with active and relapsing disease course, from 7 rheumatology clinics in Turkey were evaluated retrospectively. All the patients fulfilled the American College of Rheumatology Classification Criteria for TA [1]. Clinical and laboratory findings including serial radiological imaging data were carefully noted. Results: Mean number of conventional IS agents used before anti-TNF therapy was 2.25 (2-5) per patient. Eleven patients (58%) were treated with infliximab, 6 (32%) with etanercept and 2 (10%) with adalimumab. Remission was achieved in 10/19 (53%) patients with anti-TNF therapy. Partial remission with the suppression of disease activity was observed in 3 (16%) cases, while no response was attained in 6 (31%) cases. Treatment was discontinued in 9 patients. However the reason for discontinuation was an adverse event in only a single patient; this patient developed peritoneal tuberculosis. Other reasons for discontinuations were inadequate response in 4 patients, achieving remission in 3 and inability to go on supplying the treatment in 1 patient. One patient who responded none of the IS treatments died because of uncontrolled disease activity during the study period. Conclusion: This case series suggest that anti-TNF therapy should be considered as a relatively safe alternative therapeutic option for TA refractory to conventional IS treatments. Risk of reactivation of tuberculosis is the major concern, especially in endemic areas, thus adequate measures must be taken. Further randomized and larger studies are needed to confirm the potential risks and benefits of anti-TNF treatment in TA. References: 1. Arend WP, Michel BA, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990;33:1129-34. Disclosure of Interest: None declaredCitation: Annals of the Rheumatic Diseases, volume 69, supplement 3, year 2010, page 237Session: Vasculitis (Poster Presentations )