ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2780

Insufficient Use of Corticosteroids Results in Higher Relapse in Takayasu Arteritis

Tomoyuki Muto1, Tsuyoshi Shirai2, Hiroshi Fujii1, Tomonori Ishii3 and Hideo Harigae3, 1Tohoku University Graduate School of Medicine, Sendai, Japan, 2Medicine, Stanford University School of Medicine, Stanford, CA, 3Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Date: Tuesday, October 23, 2018

Title: Vasculitis Poster III: Immunosuppressive Therapy in Giant Cell Arteritis and Polymyalgia Rheumatica

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Takayasu arteritis (TAK) is the chronic granulomatous inflammation of the aorta, its major branches. Although Corticosteroids, such as prednisolone (PSL), and immunosuppressants are key drugs for the treatment of TAK, relapse is frequent when treatment is tapered and there is limited evidence concerning optimal dose for PSL as initial treatment. The aim of this study is to reveal the correlation between PSL dose and relapse in TAK.

Methods: One hundred and five patients with TAK satisfying the criteria of Japanese Circulation Society and American College of Rheumatology in our institution during 1990 to 2015 were enrolled. Clinical characteristics and outcome of patients with TAK were retrospectively evaluated. The relapse free period was assessed according to the difference in initial treatments.

Results: Among 105 patients with TAK, relapse was observed in 58 patients (55.2 %) during a median 56 months follow-up. Male gender and younger age of onset were significantly associated with relapse. Although PSL ≤ 30 mg/day was preferably prescribed for patients with lower inflammatory markers as monotherapy compared to PSL ≥ 40 mg/day (87.2 % vs 51.8 %), a significantly higher relapse rate was observed in PSL ≤ 30 mg/day group (hazard ratio 1.69, p=0.048). Furthermore, the relapse free period was improved in patients treated with a PSL dose ≥ 50 mg/day compared to those with a PSL dose 40 mg /day. In addition, combination therapy with immunosuppressants improved the relapse free period compared with PSL monotherapy in the short term (relapse free rate; 82.4 vs 55.6 % at 12 months).

Conclusion: The lower-dose PSL monotherapy resulted in a higher relapse rate compared to the higher-dose PSL, even when disease activity was low. Furthermore, combination therapy could improve the relapse free period at least in the short term. These results indicate that higher doses of PSL or combination therapy with immunosuppressive drugs are desirable strategies for remission induction in TAK, because it has the potential to decrease the relapse rate and suppress further vascular damage in patients with TAK.

Disclosure: T. Muto, None; T. Shirai, None; H. Fujii, None; T. Ishii, None; H. Harigae, None.

To cite this abstract in AMA style:

Muto T, Shirai T, Fujii H, Ishii T, Harigae H. Insufficient Use of Corticosteroids Results in Higher Relapse in Takayasu Arteritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/insufficient-use-of-corticosteroids-results-in-higher-relapse-in-takayasu-arteritis/. Accessed .

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