Immunomodulatory drugs for maintaining remission in Takayasu arteritis

For people with Takayasu arteritis, long-term high-dose oral corticosteroids are continued until remission of disease activity is achieved (ie the patient’s symptoms resolve, their organ function stabilises and their inflammatory markers normalise). The optimal duration is unknown.

The dose may then be tapered very slowly under specialist advice. An example of tapering long-term, high-dose oral corticosteroids can be found in Example of tapering long-term, high-dose oral corticosteroids for systemic vasculitides.

Combination therapy, with oral corticosteroids and another immunomodulatory drug, is recommended for corticosteroid sparing (to minimise the total dose and adverse effects of corticosteroids)Maz, 2021. Corticosteroid-sparing is particularly important because Takayasu arteritis is a disease that mainly affects young females. Most patients with Takayasu arteritis cannot completely stop oral corticosteroids and need to stay on combination therapy long term.

Immunomodulatory drugs used by specialists for Takayasu arteritis may include azathioprine, leflunomide, methotrexate and tocilizumabHellmich, 2020Maz, 2021.