Updates on the Treatment and Management of Large Vessel Vasculitis
Abstract
Background: Large vessel vasculitis (LVV), encompassing giant cell arteritis (GCA) and Takayasu arteritis (TAK), causes granulomatous inflammation of large- and medium-sized arteries with potentially devastating ischemic complications. Glucocorticoids remain first-line therapy but carry significant long‑term morbidity.
Methods: This narrative review synthesizes current evidence on the classification, diagnosis, monitoring, and management of LVV, incorporating data from randomized controlled trials, meta‑analyses, and international guidelines.
Results: Advances in vascular imaging have improved diagnostic accuracy and increasingly supplement or replace temporal artery biopsy. In GCA, phase 3 trials have demonstrated that tocilizumab and upadacitinib have superior remission rates and glucocorticoid-sparing effects. In TAK, tumour necrosis factor inhibitors remain the preferred biologic for refractory disease, with emerging evidence supporting Janus kinase (JAK) inhibition and novel disease-modifying anti-rheumatic drug combinations.
Conclusion: Targeted therapies have transformed LVV management, though reliable biomarkers for disease activity and consensus on optimal treatment duration remain unmet needs.
Keywords: large vessel vasculitis, giant cell arteritis, Takayasu arteritis, tocilizumab, upadacitinib, glucocorticoid-sparing, JAK inhibitors
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