Stratégie thérapeutique dans l’artérite à cellules géantes

Abstract

Giant cell arteritis (GCA) is a primary vasculitis of medium or large arteries occurring in subjects over 50 years of age. Despite its frequency, there is no consensus on therapeutic modalities. Indeed, prolonged corticosteroid therapy is the treatment of choice but its side effects encourage to seek new therapeutic strategies. Among the usual immunosuppressants, the benefit of methotrexate (MTX) is poorly evaluated both on cortisone sparing and relapse prevention. Other immunosuppressants have not shown any clear interest (azathioprine) or are responsible for significant adverse effects (cyclophosphamide, disulone). In recent years, biotherapies have been a new therapeutic perspective. After demonstrating the ineffectiveness of TNF-alpha inhibitors, tocilizumab (TCZ) therapy showed interest in two randomized, placebo-controlled trials. However, indication for this biotherapy and progress at cessation of treatment are still matter of debate. Measures to prevent the thrombotic risk by anti-platelet therapy or prevention of complications associated with prolonged corticosteroid therapy are also necessary.