Wind of Change in the Treatment of Childhood-Onset Takayasu Arteritis: a Systematic Review.
PURPOSE OF REVIEW
We lack evidence-based data for the treatment of childhood-onset Takayasu arteritis (c-TA) since it is a rare disease in children. In this systematic literature review, we aimed to evaluate the treatment choices in c-TA patients and integrate our experience for the treatment of our patients in the recent years/in the biologic era.


RECENT FINDINGS
We reviewed 24 articles addressing treatments of 413 c-TA patients. Steroids were given to 352 patients (85.2%) as the main immunosuppressive therapy. Other immunosuppressive agents included methotrexate (37.3%), cyclophosphamide (24.5%), azathioprine (16.9%), and mycophenolate mofetil (7.9%). Besides, various biological agents were used, including tumor necrosis factor-alpha inhibitors in 70 of 107 c-TA patients (65.4%) and interleukin-6 inhibitors in 33 of them (30.8%). Biologics are increasingly used in our center as well. Even in severe patients, CYC is switched to either anti-TNF or antiIL6 once disease control is achieved. Recently, in addition to conventional immunosuppressants, biologics are increasingly used in c-TA. We have revised our treatment protocol to start with 1-3 doses of high-dose steroids and CYC, in a child with TA with types III-V involvement and high acute phase reactants; once clinical features subside and CRP normalizes, biologics should be started to replace CYC while decreasing the steroid dose.
['Sener|Seher|S|0000-0003-1564-8996', 'Basaran|Ozge|O|0000-0002-8534-0930', 'Ozen|Seza|S|0000-0003-2883-7868']
D001379:Azathioprine D002648:Child D006801:Humans D007166:Immunosuppressive Agents D013625:Takayasu Arteritis D016896:Treatment Outcome D000079424:Tumor Necrosis Factor Inhibitors
Treatment Childhood-onset Takayasu arteritis Tumor necrosis factor-alpha inhibitors Interleukin-6 inhibitors Pediatric Takayasu