The objective of this study was to report the long-term use of
tumor necrosis factor (
TNF) inhibitors in case series of patients with
Takayasu's arteritis refractory to standard immunosuppressive treatment. Nine women (median age of 29 years) with refractory
Takayasu's arteritis were treated with
TNF inhibitors. Prior to
TNF inhibitor administration, all patients received standard immunosuppressive treatment for 16 to 112 months including
steroids and
immunomodulators. All but one patient presented with high activity of disease (median ESR 80 mm/h,
C-reactive protein level 16.8 mg/l,
interleukin-6 level 7.2 pg/ml) that was confirmed with positron emission tomography (PET) with (18)F-deoxyglucose. Eight patients were treated with
infliximab and one was treated with
adalimumab, respectively. The median
duration of treatment was 36 months (12 to 84 months). For induction treatment, we used
infliximab 200-300 mg every 4-6 weeks and
adalimumab 40 mg every 2 weeks. The treatment resulted
in complete remission in five (55.6%) patients and incomplete remission in three (33.3%) patients. We were able to taper the dose of
prednisone to ≤10 mg daily in all patients. Median levels of ESR,
C-reactive protein, and
interleukin-6 diminished to 20 mm/h, 1.0 mg/l, and 1.0 pg/ml, respectively. Repeated PET showed lower activity of
vasculitis in six (85.7%) of seven patients. The treatment was safe and well-tolerated. Only one patient developed
allergic reactions after infusions of
infliximab. Four patients developed relapse of
vasculitis when we tried to increase the dosing interval of
infliximab to 6-8 weeks.
TNF inhibitors were highly effective and safe in patients with refractory
Takayasu's arteritis.