Objective: Takayasu arteritis (TA) is a chronic and relapsing vasculitis. The objectives of this study were to describe the characteristics and identify predictive factors associated with successful treatment discontinuation in a cohort of patients with TA.
Methods: We conducted a retrospective monocentric analysis of patients with TA, followed at the tertiary Vasculitis Clinic in Toronto, from inception to January 2021, and for at least 2 years after diagnosis. The objectives were to determine the frequency of patients whose immunosuppressive medications had been stopped for at least 6 months before their last follow-up visit and whose disease remained inactive, and analyze their characteristics, in comparison with the remaining of the cohort still on medications for TA.
Results: The cohort included 65 patients (95.4% women; 46.7% white). Twenty-five (38.5%) patients had successfully discontinued their treatment for more than 6 months at their last visit. Median disease duration was 18 years (IQR, 10-23 years) in the group off treatment, compared to 9 years (IQR, 5.3-16.0 years) in the group still on treatment (P = 0.004). Renal artery involvement was less frequent in patients who had stopped their immunosuppressants, especially left renal artery (P = 0.035). Median CRP level at diagnosis was 16.4 mg/L (IQR, 5.4-32.2 mg/L) in the group off treatment, and 45 mg/L (IQR, 15.0-75.5 mg/L) in the group on treatment (P = 0.023). No other difference was found when comparing disease characteristics of the two groups, on or off medications.
Conclusion: One third of TA patients were able to discontinue their treatment. They had lower CRP levels at diagnosis, less frequent renal artery involvement and longer disease duration. No other specific disease features seem to help identify patients with greater chances to be weaned off treatment successfully.
Keywords: Cessation; Immunosuppressants; Large vessel vasculitis; Takayasu arteritis; Vasculitis.
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