OA36 Treatment of Takayasu’s arteritis with anti-tumour necrosis factor: real world data from a UK tertiary referral centre

Abstract

Abstract Background/Aims Takayasu’s arteritis (TAK) is a rare granulomatous vasculitis affecting the aorta and its major branches. It is associated with significant morbidity. Initial treatment typically consists of corticosteroids and one or more conventional synthetic steroid sparing agents e.g. methotrexate/mycophenolate. In the case of disease progression or inability to wean corticosteroids, additional therapy in the form of biologic medications may be necessary. Tocilizumab is approved for the treatment of Takayasu’s arteritis in the UK, while anti-TNF therapies are not commissioned for this indication. This stands in contrast to guidelines from the USA, which prefer anti-TNF as a first line biologic agent. We describe the characteristics and outcomes of patients treated with anti-TNF at a single UK centre. Methods We retrospectively evaluated 14 Takayasu’s arteritis patients treated with anti-TNF agents out of a total cohort of 158 patients at a tertiary Takayasu’s arteritis clinic at a single UK academic centre. Results 14/158 patients (8.8%) received anti-TNF therapy for treatment of active TAK. The average age at diagnosis was 27 years. 93% (13/14) patients were female. 71% (10/14) were Caucasian and 3/14 (21%) were Asian. Prior treatment with prednisolone was ubiquitous. 5/14 (35.7%), 1/14 (7.1%), 4/14 (28.5%) and 3/14 (21%) received treatment with 1, 2, 3 or 4 csDMARDs respectively. 78.5% received methotrexate and 64.5% of patients received azathioprine with cyclophosphamide (35%) and mycophenolate mofetil (28.5%) less commonly used. 6/14 (42.8%) of the cohort had a co-existent justification for anti-TNF treatment e.g. ankylosing spondylitis, uveitis or Crohn’s disease. 100% of the cohort had stenotic/occlusive disease prior to anti-TNF treatment with 6/14 (42.8%) also having abnormal vascular dilatation. 4/14 (28.5%) experienced treatment failure defined as active inflammation or disease progression. 3 patients experienced radiographic progression (stenosis or dilatation) and 1 early treatment failure. Total time on anti TNF treatment for these four patients were 2 (early treatment failure), 13, 15 and 93 months. 71.5% of patients had stable radiographic appearances during an average total treatment time of 70 months (range 24-120). Conclusion This retrospective examination of patients with severe Takayasu’s arteritis treated with anti-TNF at a specialist centre demonstrates that 71.5% of patients had stable angiographic disease over a long duration of follow up, suggesting anti-TNF therapy may be an option for those patients for whom tocilizumab is ineffective or not tolerated. Disclosure M. Colquhoun: Honoraria; Support to attend a conference from Pfizer. R. Maughan: None. A. Porter: None. J. Satara: None. S. Hanlon: None. J. Nouza: None. T.A. Youngstein: None. J. Mason: None.