Current and innovative therapeutic strategies for the treatment of giant cell arteritis. (4th May 2021)

• Record Type: Journal Article
• Authors: Sebastian, Alwin; Tomelleri, Alessandro; Dasgupta, Bhaskar
• Is Part Of: Expert opinion on orphan drugs. Volume 9:Number 5(2021)
• Page Start: 161
• Page End: 173
• Publication Date: 2021-05-04
• Subjects: Bdmards -- csDMARDs -- biologic therapy -- clinical trials -- giant cell arteritis -- glucocorticoids -- large-vessel vasculitis -- therapy; Orphan drugs -- Periodicals; Rare diseases -- Periodicals; Chemotherapy -- Periodicals; 615.1
• DOI: 10.1080/21678707.2021.1932458
• Languages: English
• ISSNs: 2167-8707

Abstract

ABSTRACT: Introduction : Glucocorticoids represent a highly effective treatment for giant cell arteritis (GCA); however, steroid-dependency frequently hinders an adequate dose reduction. This has led to a flourishing interest in new therapeutic strategies. Areas covered : An analysis of the treatments for GCA was conducted and structured in four sections: summary data supporting the use of glucocorticoids; uncertainty regarding the use of antithrombotic agents are discussed; studies on different conventional steroid-sparing agents are reported; controlled trials with already available biologic agents and the design of those still ongoing are presented. The basis for this review is a literature search on PubMed of studies published until 31 st December 2020 on GCA treatment. Expert opinion : New GCA patients should be stratified, and therapeutic management should be tailored accordingly. High-risk patients should be treated early with steroid-sparing agents. However, current evidence only supports the use of tocilizumab, with conflicting data on methotrexate. Results of controlled trials evaluating other agents, like mavrilimumab, will be released soon; hopefully, this will lead to their inclusion as alternatives to tocilizumab. Even if biologic drugs seem highly effective, their use could be limited by high costs; hence, clinical research should not forget about less expensive conventional agents, such as leflunomide.