Treatment of refractory temporal arteritis with adalimumab.

Abstract

High-dose corticosteroids (CS) are the mainstay of treatment for temporal (giant cell) arteritis (TA). A usually required long-term treatment with CS, ranging from 1 to 5 years or more, frequently leads to serious side effects in about 60% of patients. There is no conclusive evidence about the role of immunosuppressive agents like methotrexate and azathioprine in the treatment of TA. There are few reports of treatment of refractory or steroid-dependent TA with tumor necrosis factor alpha (TNF-alpha) inhibitors including infliximab and etanercept. TA is characterized by infiltration of the vessel wall by macrophages, giant cells, and T lymphocytes, with production of several cytokines responsible for the acute phase response. TNF-alpha has been demonstrated in up to 60% of the cells in all areas of inflamed arteries by immunohistochemical techniques; hence, it could play a pivotal role in the pathogenesis of TA. We report the first case of resistant TA, which was treated successfully with adalimumab, a fully human recombinant IgG1, anti-TNF-alpha monoclonal antibody. The efficacy of TNF-alpha inhibitors in resistant TA should be studied in larger, controlled studies.

• Authors: M Mubashir Ahmed, Eisha Mubashir, Samina Hayat, Marjorie Fowler, Seth Mark Berney
• Journal: Clinical rheumatology (Clin Rheumatol) Vol. 26 Issue 8 Pg. 1353-5 (Aug 2007) ISSN: 0770-3198 [Print] Germany
• PMID: 16944071 (Publication Type: Case Reports, Journal Article)

Chemical References

• Adrenal Cortex Hormones
• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Immunologic Factors
• Adalimumab

Topics

• Adalimumab
• Adrenal Cortex Hormones (adverse effects, pharmacology)
• Aged
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Humanized
• Drug Resistance
• Female
• Giant Cell Arteritis (drug therapy)
• Humans
• Immunologic Factors (therapeutic use)