Infliximab May Lower Glucocorticoid Requirements, Lead to Remission in Takayasu Arteritis

The following article is part of conference coverage from the European League Against Rheumatism (EULAR) Congress 2018 in Amsterdam, The Netherlands. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from EULAR 2018.

Treatment of active Takayasu arteritis with infliximab may result in remission or in a diminished requirement for glucocorticoids, according to research presented at the European League Against Rheumatism (EULAR) Congress 2018, held in Amsterdam, June 13 to 18, 2018.

For this open-label clinical trial (ClinicalTrials.gov identifier: NCT02457585), 11 patients with active — according to the National Institutes of Health criteria — Takayasu arteritis were administered infliximab (intravenous infusions; starting dose, 5 mg/kg) at baseline and at 2 and 6 weeks, followed by infusions every 8 weeks for up to 46 weeks. Patients were followed until 54 weeks, and patients who had indications of partial remission at week 30 were given a higher infliximab dose (1.5 mg/kg). Study participants who were resistant to infliximab treatment were removed from the study. Patients with active disease or high levels of C-reactive protein or high erythrocyte sedimentation rates at 38 and 46 weeks were also administered higher doses of infliximab (with a 1.5 mg/kg increment at each time point, up to 9.5 mg/kg). Patients were assessed with positron emission tomography-computed tomography (PET-CT) at baseline and at 30 weeks. The study’s primary outcome was partial or complete remission at that time point.

At 30 weeks, 3 (27.3%) and 6 (54.5%) patients exhibited complete and partial remission, respectively. At 30 weeks, improvements were also observed for secondary outcomes compared with baseline levels: Indian Takayasu Clinical Activity Score 2010 (P =.004), ITAS.A (P =.003), serum levels of erythrocyte sedimentation rates (P =.031), and C-reactive protein (P =.019). Disease activity was also reduced at 30 weeks vs baseline as indicated by PET imaging, with lower maximum standardized uptake value (P =.023), target-to-vein ratio (P =.032), and target-to-liver ratio (P =.014). In addition, nonsignificant reductions in pentraxin-3 serum levels, soluble human leukocyte antigen-E, and interleukin-6 levels were recorded, and levels of TNF-α increased. No serious adverse events were reported.  

“Treatment with [infliximab] may lead to remission or improvement with lower glucocorticoid requirement in [active Takayasu arteritis],” concluded the study investigators.

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Reference

Park EH, Lee EY, Lee YJ, Ha YJ, Choi BY, Yoo WH. Infliximab therapy in patients with Takayasu arteritis. Presented at: European League Against Rheumatism (EULAR) Congress 2018; June 13-16, 2018; Amsterdam, The Netherlands. Abstract OP0234.