Management of large-vessel vasculitis

Curr Opin Rheumatol. 2019 Jan;31(1):25-31. doi: 10.1097/BOR.0000000000000561.


Purpose of review: Glucocorticoids are the mainstay of therapy for large-vessel vasculitis, but potential toxicity and frequent relapses led to studies with nonbiologic and biologic glucocorticoid-sparing agents. The aim of this review is to discuss the recent evidence for the management of giant cell arteritis (GCA) and Takayasu arteritis (TAK).

Recent findings: Tocilizumab proved to be a powerful glucocorticoid-sparing agent for GCA in a randomized placebo-controlled trial, whereas the trials with tocilizumab and abatacept failed to show a significant difference from placebo in relapse-free survival rate in TAK. Further trials are awaiting for establishing the role of abatacept and ustekinumab for GCA, and rituximab and tumor necrosis factor inhibitors, including certolizumab for TAK, as well as nonbiologic agents for both indications.

Summary: Despite recent randomized controlled trials with biologic agents, management of large-vessel vasculitis largely depends on observational studies. Well designed controlled trials using validated outcome measures in large number of patients, identification of biologic markers that could guide the choice of targeted treatments, and standardization of disease assessment including imaging modalities are unmet needs for the management of large-vessel vasculitis.

Publication types

  • Review

MeSH terms

  • Abatacept / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use*
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Biological Products / therapeutic use*
  • Certolizumab Pegol
  • Giant Cell Arteritis / drug therapy*
  • Glucocorticoids / therapeutic use*
  • Humans
  • Recurrence
  • Takayasu Arteritis / drug therapy*
  • Treatment Outcome
  • Ustekinumab / therapeutic use


  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal, Humanized
  • Biological Products
  • Glucocorticoids
  • Abatacept
  • Ustekinumab
  • tocilizumab
  • Certolizumab Pegol