Chu Cong-Qiu
Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland Oregon 97239 USA.
Rheumatology Section, Veterans Affairs Portland Health Care System, Portland Oregon 97239 USA.
Rheumatol Immunol Res. 2023 Dec 19;4(4):188-195. doi: 10.2478/rir-2023-0028. eCollection 2023 Dec.
Glucocorticoids (GC) remains the mainstay for management of large vessel vasculitis (LVV). Recent introduction of interleukin-6 signaling blocker, tocilizumab has substantially changed the practice in management of patients with LVV, in particular, giant cell arteritis (GCA). Benefit of tocilizumab to patients with Takayasu arteritis (TAK) is supported by observational studies, but randomized clinical trials are lacking. Addition of tocilizumab enables reduction of the total amount of GC in patients with GCA, but GC burden remains high and to be further reduced. Ongoing studies aim at minimal use of GC or even GC-free. Tumor necrosis factor inhibitors appear to be beneficial to TAK despite their ineffectiveness to GCA. Randomized clinical trials are undergoing to target other inflammatory cytokines in both GCA and TAK. Janus kinase inhibitors alone or in combination with conventional disease modifying anti-rheumatic drugs showed promising results in treatment of TAK.
糖皮质激素（GC）仍然是大血管血管炎（LVV）治疗的主要药物。白细胞介素-6信号阻滞剂托珠单抗的近期应用显著改变了LVV患者的治疗方式，尤其是巨细胞动脉炎（GCA）。托珠单抗对高安动脉炎（TAK）患者的益处得到了观察性研究的支持，但缺乏随机临床试验。添加托珠单抗可减少GCA患者的GC总量，但GC负担仍然很高，有待进一步降低。正在进行的研究旨在尽量减少GC的使用甚至不使用GC。肿瘤坏死因子抑制剂尽管对GCA无效，但似乎对TAK有益。针对GCA和TAK中的其他炎性细胞因子的随机临床试验正在进行。单独使用或与传统改善病情抗风湿药物联合使用的Janus激酶抑制剂在TAK治疗中显示出有希望的结果。
