Comment on: Rituximab therapy for Takayasu arteritis: a seven patients experience and a review of the literature

Abstract

Sir, Takayasu arteritis (TAK) is a granulomatous vasculitis affecting large vessels, including the aorta and its main branches. It has a female preponderance and the diagnosis is usually made in the second or third decade of life. Imperfect activity scores mainly relying on a modified Birmingham Vasculitis Activity Score and scores including imaging have been proposed [1]. Treatment strategies used in the management of TAK are not evidence-based due to a paucity of randomised controlled trials. In general, disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate (MTX), azathioprine (AZA), mycophenolate mofetil (MMF), leflunomide (LEF) and cyclophosphamide (CYC) in selected cases, alongside steroids are considered as mainstay of treatment. Furthermore, biologic agents such as TNF-α inhibitors, especially infliximab (IFX), interleukin-6 blockade with tocilizumab (TCZ) and B-cell depletion with rituximab (RTX) attracted attention due to efficacy in mainly refractory TAK cases [2].