Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis.

Autor:	de Souza AWS; From the Rheumatology Division, Universidad Federal de São Paulo, São Paulo, Brazil., Sato EI; From the Rheumatology Division, Universidad Federal de São Paulo, São Paulo, Brazil., Brance ML; School of Medicine, Rosario National University, Santa Fe, Argentina., Fernández-Ávila DG; Rheumatology Unit, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia., Scolnik M; Rheumatology Unit, Hospital, Italiano de Buenos Aires, Buenos Aires, Argentina., Magri SJ; Rheumatology Unit, Hospital Italiano de La Plata, La Plata, Buenos Aires, Argentina., Ugarte-Gil MF; School of Medicine, Universidad Cientifica del Sur, Lima, Peru., Flores-Suárez LF; Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico., Saldarriaga-Rivera LM; Rheumatology Unit, Hospital Universitario San Jorge, Risaralda, Colombia., Babini A; Rheumatology Unit, Hospital Italiano de Cordoba, Cordoba., Zamora NV; Rheumatology Unit, Hospital San Jose, Pergamino, Argentina., Acosta Felquer ML; Rheumatology Unit, Hospital, Italiano de Buenos Aires, Buenos Aires, Argentina., Vergara F; Immunology Unit, Hospital Central, Mendoza, Argentina., Carlevaris L; Rheumatology Unit, Hospital Privado de Mendoza, Godoy Cruz, Argentina., Scarafia S; Rheumatology Unit, Hospital Municipal San Cayetano, Virreyes, Argentina., Soriano Guppy ER; Rheumatology Unit, Hospital, Italiano de Buenos Aires, Buenos Aires, Argentina., Unizony S; Vasculitis and Glomerulonephritis Center, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Jazyk:	angličtina
Zdroj:	Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases [J Clin Rheumatol] 2023 Oct 01; Vol. 29 (7), pp. 316-325. Date of Electronic Publication: 2023 Aug 09.
DOI:	10.1097/RHU.0000000000002004
Abstrakt:	Objective: To develop the first evidence-based Pan American League of Associations for Rheumatology (PANLAR) guidelines for the treatment of Takayasu arteritis (TAK). Methods: A panel of vasculitis experts developed a series of clinically meaningful questions addressing the treatment of TAK patients in the PICO (population/intervention/comparator/outcome) format. A systematic literature review was performed by a team of methodologists. The evidence quality was assessed according to the GRADE (Grading of Recommendations/Assessment/Development/Evaluation) methodology. The panel of vasculitis experts voted each PICO question and made recommendations, which required ≥70% agreement among the voting members. Results: Eleven recommendations were developed. Oral glucocorticoids are conditionally recommended for newly diagnosed and relapsing TAK patients. The addition of nontargeted synthetic immunosuppressants (e.g., methotrexate, leflunomide, azathioprine, or mycophenolate mofetil) is recommended for patients with newly diagnosed or relapsing disease that is not organ- or life-threatening. For organ- or life-threatening disease, we conditionally recommend tumor necrosis factor inhibitors (e.g., infliximab or adalimumab) or tocilizumab with consideration for short courses of cyclophosphamide as an alternative in case of restricted access to biologics. For patients relapsing despite nontargeted synthetic immunosuppressants, we conditionally recommend to switch from one nontargeted synthetic immunosuppressant to another or to add tumor necrosis factor inhibitors or tocilizumab. We conditionally recommend low-dose aspirin for patients with involvement of cranial or coronary arteries to prevent ischemic complications. We strongly recommend performing surgical vascular interventions during periods of remission whenever possible. Conclusion: The first PANLAR treatment guidelines for TAK provide evidence-based guidance for the treatment of TAK patients in Latin American countries. Competing Interests: D.G.F.-Á. is consultant to Abbvie, Bristol Myers-Squibb, Eli Lilly, Fresenius Kabi, Janssen, Novartis, and Pfizer. M.V.S. is a speaker for and consultant to and receives research support from Abbvie, Bristol Myers-Squibb, GlaxoSmithKline, Janssen, Eli Lilly, Pfizer, Roche, and AstraZeneca. S.J.M. is a speaker for and consultant to and receives research support from Abbvie, Boehringer Ingelheim, GlaxoSmithKline, and Janssen. M.F.U.-G. receives research support and consulting fee from and is a speaker for Janssen, Pfizer, AztraZeneca, and GlaxoSmithKline. L.F.F.-S. is a speaker for Nippon Boehringer Ingelheim Co Ltd, Roche México, and Werfen Mexico. L.M.S.-R. is a speaker for and consultant to the advisory board of Novartis, Pfizer, Janssen, Bristol-Myers Squibb, Sanofi-Genzyme, Biopas, Amgen, Boehringer, Roche, and Eli Lilly. A.B. is a speaker and consultant to Abbvie, GlaxoSmithKline, Janssen, Pfizer, Boehringer Ingelheim, and Bristol-Myers Squibb. E.R.S.G. is a speaker for and consultant to and receives research support from Abbvie, Amgen, Bristol Myers-Squibb, Janssen, Eli Lilly, Novartis, Pfizer, Roche, Sandoz, and UCB. S.U. is a consultant to and receives research support from Kiniksa, Janssen, and Genentech. The other authors declare no conflict of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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