Pharmacological advances in giant cell arteritis treatment

Abstract

A granulomatous vasculitis of the medium and large vessels, giant cell arteritis (GCA) is a persistent, idiopathic condition. The overlapping phenotypes of this condition include conventional cranial arteritis and extra-cranial GCA, also known as large-vessel GCA. Vascular problems linked with considerable vessel involvement may partly be caused by delayed diagnosis, emphasizing the necessity of early detection and the fast beginning of appropriate therapy. The cornerstone of treatment for GCA is glucocorticoids, but using them for an extended period has numerous, often severe, side effects. We aim to explore the most recent literature on GCA therapies to investigate the current and potential therapeutic options for induction and maintaining treatment in GCA. By now, only tocilizumab is approved for GCA treatment, but several other biological drugs may be efficient and safe for GCA patients, like abatacept, baricitinib and upadacitinib, mavrilimumab, secukinumab, ustekinumab, and anakinra.

Keywords

Vasculitis / giant cell arteritis / biological drugs / anti-interleukin 6 / inflammation

References

[1] Ostberg G. Morphological changes in the large arteries in polymyalgia arteritica. Acta Med Scand Suppl. 1972; 533: 135-59.

[2] Ostberg G. Temporal arteritis in a large necropsy series. Ann Rheum Dis. 1971; 30: 224-35.

[3] Prieto-González S, Arguis P, García-Martínez A, Espígol-Frigolé G, Tavera-Bahillo I, Butjosa M, et al. Large vessel involvement in biopsy-proven giant cell arteritis: prospective study in 40 newly diagnosed patients using CT angiography. Ann Rheum Dis. 2012; 71: 1170-6.

[4] Li KJ, Semenov D, Turk M, Pope J. A meta-analysis of the epidemiology of giant cell arteritis across time and space. Arthritis Res Ther. 2021; 23: 82.

[5] Younger DS. Giant Cell Arteritis. Neurol Clin. 2019; 37: 335-4.

[6] Ramon A, Greigert H, Ornetti P, Bonnotte B, Samson M. Mimickers of Large Vessel Giant Cell Arteritis. J Clin Med. 2022; 11: 495.

[7] Antonio AA, Santos RN, Abariga SA. Tocilizumab for giant cell arteritis. Cochrane Database Syst Rev. 2021; 8: CD013484.

[8] Stone JH, Tuckwell K, Dimonaco S, Klearman M, Aringer M, Blockmans D, et al. Trial of Tocilizumab in Giant-Cell Arteritis. N Engl J Med. 2017; 377: 317-28.

[9] Frohman L, Wong ABC, Matheos K, Leon-Alvarado LG, Danesh-Meyer HV. New developments in giant cell arteritis. Surv Ophthalmol. 2016; 61: 400-21.

[10] Lavergne A, Dumont A, Deshayes S, Boutemy J, Maigné G, Silva NM, et al. Efficacy and tolerance of methotrexate in a real-life monocentric cohort of patients with giant cell arteritis. Semin Arthritis Rheum. 2023; 60: 152192.

[11] Jover JA, Hernández-Garcia C, Morado IC, Vargas E, Bañares A, Fernandez-Gutierrez B. Disparate results in studies of methotrexate plus corticosteroids in the treatment of giant cell arteritis: comment on the article by Hoffman et al. Arthritis Rheum. 2003; 48: 1158-9.

[12] Caporali R, Cimmino MA, Ferraccioli G, Gerli R, Klersy C, Salvarani C, et al. ; Systemic Vasculitis Study Group of the Italian Society for Rheumatology. Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2004; 141: 493-500.

[13] Sciascia S, Piras D, Baldovino S, Russo A, Naretto C, Rossi D, et al. Mycophenolate mofetil as steroid-sparing treatment for elderly patients with giant cell arteritis: report of three cases. Aging Clin Exp Res. 2012; 24: 273-7.

[14] Karabayas M, Dospinescu P, Fluck N, Kidder D, Fordyce G, Hollick RJ, et al. Evaluation of adjunctive mycophenolate for large vessel giant cell arteritis. Rheumatol Adv Pract. 2020; 4: rkaa069.

[15] Narváez J, Estrada P, LLop D, Vidal-Montal P, Brugarolas E, Maymó-Paituvi P, et al. Efficacy and safety of leflunomide in the management of large vessel vasculitis: A systematic review and metaanalysis of cohort studies. Semin Arthritis Rheum. 2023; 59: 152166.

[16] Quartuccio L, Isola M, Bruno D, Treppo E, Gigante L, Angelotti F, et al. Treatment strategy introducing immunosuppressive drugs with glucocorticoids ab initio or very early in giant cell arteritis: A multicenter retrospective controlled study. J Transl Autoimmun. 2020; 3: 100072.

[17] Goglin S, Chung SA. New developments in treatments for systemic vasculitis. Curr Opin Pharmacol. 2022; 66: 102270.

[18] Koster MJ, Crowson CS, Giblon RE, Jaquith JM, Duarte-García A, Matteson EL, et al. Baricitinib for relapsing giant cell arteritis: a prospective open-label 52-week pilot study. Ann Rheum Dis. 2022; 81: 861-7.

[19] Sanada A, Abe N, Bohgaki M, Kasahara H. Therapeutic effectiveness of upadacitinib combined with glucocorticoid on remission induction and maintenance in giant cell arteritis. Rheumatology (Oxford). 2022; 61: e274-6.

[20] Ly K, Stirnemann J, Liozon E, Michel M, Fain O, Fauchais A. Interleukin-1 blockade in refractory giant cell arteritis. Joint Bone Spine. 2014; 81: 76-8.

[21] Cid MC, Unizony SH, Blockmans D, Brouwer E, Dagna L, Dasgupta B, et al. ; KPL-301-C001 Investigators. Efficacy and safety of mavrilimumab in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. Ann Rheum Dis. 2022; 81: 653-61.

[22] Deshayes S, Ly K, Rieu V, Maigné G, Silva NM, Manrique A, et al. ; French Study Group for Large Vessel Vasculitis (GEFA). Steroid-sparing effect of anakinra in giant-cell arteritis: a case series with clinical, biological and iconographic long-term assessments. Rheumatology (Oxford). 2021; 61: 400-6.

[23] Amani H, Habibey R, Shokri F, Hajmiresmail SJ, Akhavan O, Mashaghi A, et al. Selenium nanoparticles for targeted stroke therapy through modulation of inflammatory and metabolic signaling. Sci Rep. 2019; 9: 6044.

[24] Rahimnejad M, Boroujeni NN, Jahangiri S, Rabiee N, Rabiee M, Makvandi P, et al. Prevascularized Micro-/Nano-Sized Spheroid/Bead Aggregates for Vascular Tissue Engineering. Nanomicro Lett. 2021; 13: 182.

[25] Ren H, He Y, Liang J, Cheng Z, Zhang M, Zhu Y, et al. Role of Liposome Size, Surface Charge, and PEGylation on Rheumatoid Arthritis Targeting Therapy. ACS Appl Mater Interfaces. 2019; 11: 20304-15.