New Treatment Strategies in Large-vessel Vasculitis
Immunity is dependent on rapidly dividing cells that require continuous synthesis of DNA. Leflunomide, an agent widely used in rheumatoid arthritis, has immunomodulatory effects by inhibiting pyrimidine synthesis. In a recent prospective study from Brazil, favorable clinical response to leflunomide at 20 mg/day was seen in 12 of 15 TAK patients whose disease had been refractory to glucocorticoids (100%), methotrexate (100%), azathioprine (30%), cyclosporine (30%), mycophenolate mofetil (25%), and TNF-α antagonists (7%). Disease activity scores, CRP levels and prednisone use significantly declined after a median treatment period of 9 months. However, at the end of follow up, patients still required a mean daily prednisone dose of 13.9 mg (SD 8.5 mg), although it is unclear how many of these patients still required glucocorticoids. In addition, two cases had radiographic progression despite being classified in remission by clinical examination and laboratory analysis. Three patients experienced mild side effects.
Leflunomide for Takayasu Arteritis
Immunity is dependent on rapidly dividing cells that require continuous synthesis of DNA. Leflunomide, an agent widely used in rheumatoid arthritis, has immunomodulatory effects by inhibiting pyrimidine synthesis. In a recent prospective study from Brazil, favorable clinical response to leflunomide at 20 mg/day was seen in 12 of 15 TAK patients whose disease had been refractory to glucocorticoids (100%), methotrexate (100%), azathioprine (30%), cyclosporine (30%), mycophenolate mofetil (25%), and TNF-α antagonists (7%). Disease activity scores, CRP levels and prednisone use significantly declined after a median treatment period of 9 months. However, at the end of follow up, patients still required a mean daily prednisone dose of 13.9 mg (SD 8.5 mg), although it is unclear how many of these patients still required glucocorticoids. In addition, two cases had radiographic progression despite being classified in remission by clinical examination and laboratory analysis. Three patients experienced mild side effects.
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