Emerging treatments
Janus kinase (JAK) inhibitors
JAK inhibitors (e.g., tofacitinib, upadacitinib) inhibit the activity of one or more JAK enzymes and block signaling of cytokines implicated in Takayasu arteritis pathogenesis (type 1 and 2 interferons, interleukin [IL]-6, IL-12, IL-17, and IL-23). They also suppress tissue-resident memory T cells and reduce inflammatory-related vascular damage.[49][50][51] Case reports and one prospective observational study show positive results in patients with Takayasu arteritis (clinical improvement, lower radiologic disease progression, superior to methotrexate) for tofacitinib. There is a current ongoing randomized controlled trial now in phase 4 comparing methotrexate and tofacitinib.[52] There is one ongoing RCT evaluating the efficacy of upadacitinib in combination with corticosteroids, compared with placebo and corticosteroids.[53] JAK inhibitors are not included in the 2018 EULAR recommendations or the 2021 ACR guidelines.
Abatacept
T-cell-mediated mechanisms are involved in the pathogenesis of Takayasu arteritis. Abatacept inhibits activation of T cells. However, in one randomized clinical trial, addition of abatacept to a treatment regimen with prednisone did not reduce the risk of relapse in patients with Takayasu arteritis.[54] Abatacept is not currently recommended in guidelines due to lacking evidence for efficacy.[3]
Secukinumab
Secukinumab is a human monoclonal antibody that selectively binds to interleukin 17A (IL-17A). IL-17 has been implicated in the pathogenesis of Takayasu arteritis, as elevated levels of this cytokine and expansion of Th17 cells are seen in patients with this disease.[18] A 2023 trial evaluated the efficacy of secukinumab in patients with refractory Takayasu arteritis. In a single-center open-label trial, 19 patients were treated with secukinumab and compared with 34 patients treated with tumor necrosis factor (TNF)-alpha inhibitors. The overall efficacy of secukinumab was similar to that of TNF-alpha inhibitors with complete response and partial response rates of 52.6% and 64.7%, respectively, at 6 months.[55] While encouraging, these results require future validation in randomized trials.
Use of this content is subject to our disclaimer