Successful Treatment of Refractory Takayasu Arteritis with Tacrolimus: Figure 1.

Abstract

To the Editor: Takayasu arteritis (TA) is a systemic vasculitis that affects large-size vessels such as the aorta and/or its main branches. Persistent inflammation of TA leads to segmental stenosis, occlusion, dilatation, and/or aneurysm formation. TA is also accompanied by somatic symptoms, including fever, fatigue, and weight loss, and elevation of acute-phase reactants such as C-reactive protein (CRP) that correlate with disease activity. Although high-dose corticosteroid (CS) therapy is effective in TA, CS alone does not provide sustained remission in about half of patients1. CS-resistant patients with TA have been treated with immunosuppressants, including methotrexate (MTX) and azathioprine1,2. Anti-tumor necrosis factor (anti-TNF) therapy3,4 and anti-interleukin 6 receptor antibody5,6 are also promising treatments for TA. However, the new therapies for CS-resistant TA have yet to be standardized. We describe a patient with TA who was successfully treated with tacrolimus, a calcineurin inhibitor, after failed trial of conventional CS, MTX, and infliximab (IFX). This case suggests that tacrolimus … Address correspondence to Dr. Nanki; E-mail: nanki.rheu{at}tmd.ac.jp