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Szydełko-Paśko U, Przeździecka-Dołyk J, Nowak Ł, Małyszczak A, Misiuk-Hojło M. Ocular Manifestations of Takayasu's Arteritis-A Case-Based Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12113745. [PMID: 37297942 DOI: 10.3390/jcm12113745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/13/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Takayasu's arteritis (TA) is a type of vasculitis in which inflammation develops in large vessels, especially in the aorta and its branches. Our study aims to determine the prevalence and type of ocular manifestations in TA. A systematic literature search was conducted in December 2022 using three electronic databases (PubMed, Scopus, and Web of Science). The following data were extracted from each article: the name of the first author; the patient's age, sex, and origin (continent); circumstances connected with the diagnosis of TA; symptoms given by the patients; reported ocular manifestations; and administered treatment. The final analysis was based on data collected from 122 cases. Retinal ischemia, followed by optic neuropathy, cataract, and retinal artery occlusion, were the most prevalent eye conditions associated with the disease. Systemic steroid therapy, vascular procedures, and methotrexate were mainly used to treat pulseless disease. Patients mostly complained of gradual vision acuity loss, sudden vision acuity loss, ocular pain, and amaurosis fugax. The diagnosis of Takayasu's arteritis should be considered in patients presenting symptoms of visual decline/loss, ocular pain, or signs of retinal ischemia, optic neuropathy, or early cataract formation. A proper diagnosis is crucial to ensure the patient receives treatment without significant delay.
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Affiliation(s)
| | - Joanna Przeździecka-Dołyk
- Department of Optics and Photonics, Wrocław Univeristy of Science and Technology, 50-370 Wrocław, Poland
| | - Łukasz Nowak
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, 50-367 Wrocław, Poland
| | - Artur Małyszczak
- Department of Ophthalmology, Wrocław Medical University, 50-556 Wrocław, Poland
| | - Marta Misiuk-Hojło
- Department of Ophthalmology, Wrocław Medical University, 50-556 Wrocław, Poland
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Regola F, Uzzo M, Toniati P, Trezzi B, Sinico RA, Franceschini F. Novel Therapies in Takayasu Arteritis. Front Med (Lausanne) 2022; 8:814075. [PMID: 35096902 PMCID: PMC8790042 DOI: 10.3389/fmed.2021.814075] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Takayasu Arteritis (TAK) is a large-vessel vasculitis that preferentially involves the aorta and its primary branches. Cardiac involvement is frequent in TAK and is a major determinant of the patient's outcome. Glucocorticoids (GC) are the mainstay of therapy for TAK, with high doses of GC effective to induce remission. However, relapses are common and lead to repeated and prolonged GC treatments with high risk of related adverse events. Potential GC toxicity is a major concern, especially because patients with TAK are young and need to be treated for several years, often for the whole life. Conventional immunosuppressive drugs are used in patients with severe manifestations but present some limitations. New therapeutic approaches are needed for patients with refractory disease or contraindications to conventional therapies. Fortunately, major progress has been made in understanding TAK pathogenesis, leading to the development of targeted biotherapies. In particular, IL-6 and TNF-α pathways seems to be the most promising therapeutic targets, with emerging data on Tocilizumab and TNF inhibitors. On the other hand, new insights on JAK-Inhibitors, Rituximab, Ustekinumab and Abatacept have been explored in recent studies. This review summarizes the emerging therapies used in TAK, focusing on the most recent studies on biologics and analyzing their efficacy and safety.
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Affiliation(s)
- Francesca Regola
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Martina Uzzo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Nephrology and Dialysis Unit, ASST-Monza, Ospedale San Gerardo, Monza, Italy
| | - Paola Toniati
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Barbara Trezzi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Nephrology and Dialysis Unit, ASST-Monza, Ospedale San Gerardo, Monza, Italy
| | - Renato Alberto Sinico
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Nephrology and Dialysis Unit, ASST-Monza, Ospedale San Gerardo, Monza, Italy
| | - Franco Franceschini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili of Brescia, Brescia, Italy
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Alibaz-Oner F, Kaymaz-Tahra S, Bayındır Ö, Yazici A, Ince B, Kalkan K, Kanıtez NA, Kocaer SB, Yasar Bilge NS, Omma A, Durak E, Ilgın C, Akar S, Kaşifoğlu T, Önen F, Emmungil H, İnanç M, Cefle A, Aksu K, Keser G, Direskeneli H. Biologic treatments in Takayasu's Arteritis: A comparative study of tumor necrosis factor inhibitors and tocilizumab. Semin Arthritis Rheum 2021; 51:1224-1229. [PMID: 34706312 DOI: 10.1016/j.semarthrit.2021.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/04/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the treatment outcomes of TNF inhibitors and tocilizumab (TCZ) in patients with Takayasu arteritis. METHODS Takayasu arteritis patients who were refractory to conventional immunosuppressive (IS) drugs and received biologic treatment were included in this multicenter retrospective cohort study. Clinical, laboratory and imaging data during follow-up were recorded. Remission, glucocorticoid (GC) sparing effect, drug survival was compared between TNF inhibitor and TCZ treatments. Also, a subgroup matched comparison was performed between groups. RESULTS One hundred and eleven (F/M: 98/13) patients were enrolled. A total of 173 biologic treatment courses (77 infliximab, 49 TCZ, 33 adalimumab, 9 certolizumab, 3 rituximab, 1 ustekinumab and 1 anakinra) were given. Tocilizumab was chosen in 23 patients and TNF inhibitors were chosen in 88 patients as first-line biologic agent. Complete/partial remission rates between TCZ and TNF inhibitors were similar at 3rd month and at the end of the follow-up. GC dose decrease (≤4 mg) or discontinuation of GCs was achieved in a similar rate in both groups (TNF inhibitors vs TCZ: 78% vs 59%, p = 0.125). Drug survival rate was 56% in TNF inhibitors and 57% in TCZ group (p = 0.22). The use of concomitant conventional ISs did not affect the drug survival (HR =0.78, 95% CI =0.42-1.43, p = 0.42). The match analysis showed similar results between groups in terms of relapse, decrease in GC dose, surgery need and mortality. CONCLUSION The efficacy and safety outcomes and drug survival rates seem to be similar for TNF inhibitors and tocilizumab in patients with Takayasu arteritis.
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Affiliation(s)
- Fatma Alibaz-Oner
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey.
| | - Sema Kaymaz-Tahra
- Sancaktepe Prof.Dr. Ilhan Varank Training and Research Hospital, Rheumatology, Istanbul, Turkey
| | - Özün Bayındır
- Ege University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Ayten Yazici
- Kocaeli University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Kocaeli, Istanbul, Turkey
| | - Burak Ince
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine Rheumatology, Istanbul, Turkey
| | - Kübra Kalkan
- Trakya University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Edirne, Turkey
| | - Nilüfer Alpay Kanıtez
- Koc University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Sinem Burcu Kocaer
- Dokuz Eylul University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Nazife Sule Yasar Bilge
- Osmangazi University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Eskisehir, Turkey
| | - Ahmet Omma
- Ministry of Health Ankara City Hospital, Rheumatology, Ankara, Turkey
| | - Elif Durak
- Katip Celebi University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Can Ilgın
- Marmara University Faculty of Medicine, Department of Public Health, Istanbul, Turkey
| | - Servet Akar
- Katip Celebi University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Timuçin Kaşifoğlu
- Osmangazi University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Eskisehir, Turkey
| | - Fatoş Önen
- Dokuz Eylul University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Hakan Emmungil
- Trakya University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Edirne, Turkey
| | - Murat İnanç
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine Rheumatology, Istanbul, Turkey
| | - Ayşe Cefle
- Kocaeli University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Kocaeli, Istanbul, Turkey
| | - Kenan Aksu
- Ege University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Gökhan Keser
- Ege University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Haner Direskeneli
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
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Campochiaro C, Tomelleri A, Sartorelli S, Cavalli G, De Luca G, Baldissera E, Dagna L. Drug retention and discontinuation reasons between seven biologics in patients with Takayasu arteritis. Semin Arthritis Rheum 2020; 50:509-514. [PMID: 32088012 DOI: 10.1016/j.semarthrit.2020.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We retrospectively investigated drug retention rate (DRR) and reasons for discontinuation of seven biologic disease-modifying anti-rheumatic drugs (bDMARDs) in Takayasu's arteritis (TA) in a real-world setting. METHODS TA patients followed-up in our center fulfilling the 1990 ACR criteria and treated with ≥1 bDMARD were selected. Data about disease duration, number of bDMARDs, reasons for bDMARDs discontinuation, and concomitant conventional synthetic (cs)DMARDs were collected. Survival curves were examined by the Kaplan-Meier method and compared using a stratified log-rank test. 24-month DRR was calculated. Hazard ratio (HR) for concomitant csDMARDs and for previous bDMARDs was evaluated. A comparative sub-analysis between anti-TNFα drugs and tocilizumab was performed. RESULTS We identified 50 patients and 86 bDMARD-courses. No significant differences were observed in age and disease duration between the seven groups. Infliximab was the most frequent first-line bDMARD (78.6%). At bDMARDs initiation, all patients were prescribed prednisone (mean dose, 13.5 ± 10.3 mg/day) and 85.2% concomitant csDMARD therapy. 43% of treatment courses were stopped by 24 months. Golimumab had the highest DRR (71.4%), followed by infliximab (69%), adalimumab (56.3%), abatacept (50%), tocilizumab (41.1%), anakinra (0%) and rituximab (0%), p = 0.016. Concomitant csDMARDs therapy showed positive effects on DRR (HR=2.87, 95% CI=1.19-6.92, p = 0.019). Anti-TNFα drugs had significantly higher DRR compared to tocilizumab (67.2% vs 41.1%, p = 0.028). Even in these subgroups, csDMARDs showed positive effects on DRR (HR=3.79, 95% CI=1.49-9.6, p = 0.005). CONCLUSIONS Anti-TNFα agents had the highest DRR overall and a higher DRR in a head-to-head comparison with tocilizumab. Concomitant csDMARDs had a significant positive effect on bDMARDs DRR.
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Affiliation(s)
- Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare diseases, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy.
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare diseases, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Silvia Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare diseases, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare diseases, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare diseases, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Elena Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare diseases, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
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