2022ACR: In some patients with Takayasu arteritis, it may be feasible to stop treatment

Takayasu arteritis (TA), also known as high-safety vasculitis, involves the aorta and its major branches, and is a primary granulomatous vasculitis of unknown origin characterized by infiltrative inflammation of the vascular wall, resulting in wall thickening, stenosis, occlusion, or aneurysm
.
According to the data, TA is distributed worldwide, and it can occur in both men and women, but the impact on young women and Asian populations is particularly significant
.

Immunosuppression can reduce the risk of
TA artery damage and disease progression.
However, as patients age, long-term use of glucocorticoids ( GC) and other immunosuppressants pose certain risks
to health.
To date, there is no question on the effects of discontinuation of
GC, DMARD, or biologic therapy in people with TA.

At the 2022 ACR Rheumatology Annual Meeting, a cohort study was presented evaluating clinical and therapeutic parameters
associated with discontinuation of treatment in patients with TA.

The researchers analysed 158 patients from the UK with a median follow-up of 8.
4 years
.
Treatment is defined as >6 months of GC, DMARD, or biologic therapy, with discontinuation of treatment meaning 1 year
> stopping all treatment.
The safety of discontinuing treatment was assessed by continuous angiography and NIH disease activity
scores.
Baseline demographic, clinical, and treatment parameters, and initial response
to treatment were compared with those who had stopped treatment and those who did not.

The results showed that of the 158 patients, 129 patients (82%) required treatment and 29 patients (27.
1%) stopped treatment.
The duration of discontinuation of treatment was 3.
6 years
.
The investigators also found one case in which the disease relapsed after stopping the drug and required restarting treatment, but the patient did not meet the criteria for discontinuation (time to discontinuation < 1 year).

Of the 25 patients who stopped treatment, four withdrew from the trial
due to infection, non-adherence to treatment, and tolerability.
Activity scores were performed on cases that had stopped treatment, and the disease was found to be quiescent
.
Continuous angiography (aortic MRI or CT angiography) confirmed no arterial progression
in 20 patients.
Two patients showed signs of progression and were later diagnosed with atherosclerosis, and one of them had aortic dilation without systemic features
.

In addition, baseline demographic and disease severity parameters were similar
in patients who discontinued and non-discontinued treatment.
In After 2 years of treatment, patients who stopped treatment had a lower GC dose and a trend
towards reduced disease activity.
In line with this, the dosage of biologics in patients who stopped treatment was significantly reduced
.
It is worth noting that the year of discontinuation of treatment and the initiation of treatment by patients is earlier, at an older age, and the proportion of Numano V classification increases
.

In conclusion, it is feasible and safe to stop treatment completely in a subset of patients with TA
.
Initial response to treatment, duration of treatment, and Numano V artery involvement are potential predictors of successful discontinuation of treatment and, once validated, may help future stratification strategies
.

Resources

Maughan R, Porter A, Dahanayake C, Ianonne C, Alapat R, Pericleous C, Youngstein T, Mason J.
Evaluating the Safety and Factors Associated with Treatment Cessation in Takayasu Arteritis [abstract ].
Arthritis Rheumatol.
2022; 74 (suppl 9).
https://acrabstracts.
org/abstract/evaluating-the-safety-and-factors-associated-with-treatment-cessation-in-takayasu-arteritis/.
Accessed November 10, 2022.