Therapeutic effectiveness of upadacitinib combined with glucocorticoid on remission induction and maintenance in giant cell arteritis
Atsushi Sanada, Nobuya Abe, Miyuki Bohgaki, Hideki Kasahara
Abstract
Dear Editor, Large-vessel vasculitis (LVV) typically refers to the inflammatory disease of large blood vessels, predominantly affecting the aorta and its major branches. LVV is classified into two major categories: Takayasu arteritis (TAK) and GCA. The therapeutic mainstay in TAK and GCA is high-dose glucocorticoid therapy. Although immunosuppressants such as methotrexate, azathioprine and mycophenolate mofetil and biologics including anti-TNF-α antibodies, tocilizumab and abatacept are used in refractory LVV cases [1], progressive diseases manifesting as vascular stenosis and occlusion due to sustained inflammation of vessel walls are sometimes observed despite adequate anti-inflammatory treatment, especially in TAK [2, 3]. Therefore, developing new treatment alternatives is an important issue in LVV. Recently, refractory TAK cases successfully treated with tofacitinib, a Janus kinase (JAK) inhibitor, have been reported [2, 3]. However, there are few reports for the clinical effectiveness of other JAK inhibitors except tofacitinib in LVV, especially GCA. Just one successful case was demonstrated regarding the efficacy of baricitinib in a patient with relapsing GCA [4]. We here report a case of GCA concomitant with PsA successfully treated with upadacitinib, a selective JAK1 inhibitor, inducing and maintaining remission without any disease progression in imaging analyses by the combined use of glucocorticoid.