Reducing the Toxicity of Long-Term Glucocorticoid Treatment in Large Vessel Vasculitis
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RECENT ADVANCES IN LARGE VESSEL VASCULITIS ( C DEJACO AND C DUFTNER, SECTION EDITORS)
Reducing the Toxicity of Long-Term Glucocorticoid Treatment in Large Vessel Vasculitis Andriko Palmowski 1 & Frank Buttgereit 1 Accepted: 29 September 2020 # The Author(s) 2020
Abstract Purpose While glucocorticoids (GCs) are effective in large vessel vasculitis (LVV), they may cause serious adverse events (AEs), especially if taken for longer durations and at higher doses. Unfortunately, patients suffering from LVV often need longterm treatment with GCs; therefore, toxicity needs to be expected and countered. Recent Findings GCs remain the mainstay of therapy for both giant cell arteritis and Takayasu arteritis. In order to minimize their toxicity, the following strategies should be considered: GC tapering, administration of conventional synthetic (e.g., methotrexate) or biologic (e.g., tocilizumab) GC-sparing agents, as well as monitoring, prophylaxis, and treatment of GC-related AEs. Several drugs are currently under investigation to expand the armamentarium for the treatment of LVV. Summary GC treatment in LVV is effective but associated with toxicity. Strategies to minimize this toxicity should be applied when treating patients suffering from LVV. Keywords Glucocorticoids . Large vessel vasculitis . Adverse events . Takayasu arteritis . Giant cell arteritis . Prednisone . Steroids
Introduction Large vessel vasculitis (LVV) is characterized by granulomatous inflammation of “large” vessels such as the aorta or its branches [1]. The two forms of LVV, giant cell arteritis (GCA) and Takayasu arteritis (TA), can lead to severe complications such as permanent loss of vision, strokes, or potentially lethal aortic aneurysms [2, 3]. Glucocorticoids (GCs) are the mainstay of LVV therapy, and instant administration attenuates LVV-associated morbidity by potent immunosuppression. Indeed, the antiinflammatory and immunosuppressive properties of GCs are quasi-unrivalled. However, GCs may cause complications themselves. Especially long-term treatment at higher dosages (> 5 mg/day; with a positive correlation between the daily and cumulative
This article is part of the Topical Collection on Recent Advances in Large Vessel Vasculitis * Frank Buttgereit [email protected] 1
Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin, Berlin, Germany
dose and the risk for adverse events) is potentially associated with adverse events (AEs) such as cardiovascular complications, osteoporosis, infections, cataracts, diabetes mellitus, weight gain, and cushingoid habitus. Unfortunately, patients suffering from LVV are usually in need of higher GC doses, particularly at the beginning of the disease and in case of higher disease activity. Also, the occurrence of relapses may cause the need for long-term treatment with GCs. Consequently, clinicians should expect GC-related toxicity in patients suffering from LVV and implement strategies that can reduce the frequency and severity of such AEs. In this review, we will r
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