Biotherapies in large vessel vasculitis

Giant cell arteritis (GCA) and Takayasu's arteritis (TA) are large vessel vasculitis (LW) and aortic involvement is not uncommon in Behcet's disease (BD) and relapsing polychondritis (RP). Glucocorticosteroids are the mainstay of therapy in LW. However, a significant proportion of patients have glucocorticoid dependance, serious side effects or refractory disease to steroids and other immunosuppressive treatments such as cyclophosphamide, azathioprine, mycophenolate mofetil and methotrexate. Recent advances in the understanding of the pathogenesis have resulted in the use of biological agents in patients with LW. Anti-tumor necrosis factor-alpha drugs seem effective in patients with refractory Takayasu arteritis and vascular BD but have failed to do so in giant cell arteritis. Preliminary reports on the use of the anti-IL6-receptor antibody (tocilizumab), in LW have been encouraging. The development of new biologic targeted therapies will probably open a promising future for patients with LW. (C) 2016 Elsevier B.V. All rights reserved.