Giant cell arteritis (GCA) is the most common
vasculitis among elderly people. The clinical spectrum of the disease is heterogeneous, with a classic/cranial phenotype, and another extracranial or large vessel phenotype as the two more characteristic patterns. Permanent visual loss is the main short-term complication.
Glucocorticoids (GC) remain the cornerstone of treatment. However, the percentage of relapses with GC alone is high, and the rate of adverse events affects more than 80% of patients, so it is necessary to have alternative therapeutic options, especially in patients with worse prognostic factors or high comorbidity. MTX is the only
DMARD that has shown to reduce the cumulative dose of GC, while
tocilizumab is the first biologic agent approved due to its ability to decrease the relapse rate and lower the cumulative GC doses. However, apart from the
IL-6 pathway, there are other pro-inflammatory
cytokines and
growth factors involved in the typical intima
hyperplasia and
vascular remodeling of GCA. Among them, the more promising targets in GCA treatment are the
IL12/IL23 axis antagonists, IL17 inhibitors, modulators of T lymphocytes, and inhibitors of either the JAK/STAT pathway, the
granulocyte-macrophage colony-stimulating factor, or the
endothelin, all of which are updated in this review.