From the Rheumatology Division, Universidad Federal de São Paulo, São Paulo, Brazil.
School of Medicine, Rosario National University, Santa Fe, Argentina.
J Clin Rheumatol. 2023 Oct 1;29(7):316-325. doi: 10.1097/RHU.0000000000002004. Epub 2023 Aug 9.
To develop the first evidence-based Pan American League of Associations for Rheumatology (PANLAR) guidelines for the treatment of Takayasu arteritis (TAK).
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.
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.
The first PANLAR treatment guidelines for TAK provide evidence-based guidance for the treatment of TAK patients in Latin American countries.
制定首个基于循证医学的泛美风湿病协会联盟（PANLAR）治疗大动脉炎（TAK）指南。
一组血管炎专家采用 PICO（人群/干预/对照/结局）格式制定了一系列针对 TAK 患者治疗的具有临床意义的问题。一个方法学家团队进行了系统的文献回顾。根据 GRADE（推荐意见的分级/评估/制定/评价）方法评估证据质量。血管炎专家小组对每个 PICO 问题进行投票并提出建议，这些建议需要投票成员中≥70%的人达成一致。
制定了 11 项建议。对于新诊断和复发的 TAK 患者，条件推荐口服糖皮质激素。对于新诊断或复发但无器官或生命威胁的疾病，建议加用非靶向合成免疫抑制剂（如甲氨蝶呤、来氟米特、硫唑嘌呤或吗替麦考酚酯）。对于有器官或生命威胁的疾病，我们有条件地推荐使用肿瘤坏死因子抑制剂（如英夫利昔单抗或阿达木单抗）或托珠单抗，并考虑在生物制剂受限的情况下使用短疗程环磷酰胺作为替代。对于尽管使用了非靶向合成免疫抑制剂仍复发的患者，我们有条件地建议从一种非靶向合成免疫抑制剂转换为另一种，或加用肿瘤坏死因子抑制剂或托珠单抗。对于有颅动脉或冠状动脉受累的患者，我们有条件地建议使用低剂量阿司匹林预防缺血性并发症。我们强烈建议在可能的情况下，在缓解期进行手术血管介入。
首个 PANLAR TAK 治疗指南为拉丁美洲国家 TAK 患者的治疗提供了循证指导。
