Search

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.)