PO:36:252 | Long-Term Outcomes of Patients with Takayasu Arteritis in the Era of Biological Agents: a Multicenter International Study

Alessandro Tomelleri¹, Durga Prasanna Misra², Fatma Alibaz-Oner³, Chiara Marvisi⁴, Chiara Calabrese¹, Upendra Rathore², Aysegul Avcu³, Adele Del Giudice⁴, Elisabetta Olivi⁴, Caterina Ricordi⁴, Corrado Campochiaro¹, Elena Baldissera¹, Marco Matucci-Cerinic¹, Haner Direskeneli³, Carlo Salvarani⁴, Lorenzo Dagna¹ | ¹IRCCS Ospedale San Raffaele, Unità di Immunologia, Reumatologia, Allergologia e Malattie Rare Milano, Italy; ²Sanjay Gandhi Postgraduate Institute of Medical Sciences SGPGIMS, Clinical Immunology and Rheumatology Lucknow Country, India; ³Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology Istanbul, Turkey; ⁴Azienda USL-IRCCS di Reggio Emilia, Unità di Reumatologia Reggio Emilia, Italy

Objectives. Takayasu arteritis (TAK) is a chronic large-vessel vasculitis affecting mainly young individuals. While biologic agents have increasingly been used over the past decade, long-term outcome data remain limited. This study aimed to evaluate long-term disease- and therapy-related outcomes in TAK in the era of biologics.

Methods. Medical records of TAK patients followed at four centres (2 in Italy, 1 in India, 1 in Turkey) for at least 60 months were retrospectively reviewed. Baseline data included demographics, clinical features, vascular involvement, and initial treatment. Outcomes included progression of vascular damage, need for procedures, use of csDMARDs and bDMARDs, glucocorticoid (GC) tapering and discontinuation, and major complications. Logistic and linear regression were used to identify predictors of GC withdrawal, vascular procedures, and infections.

Results. A total of 119 patients (84% women; mean age at diagnosis 31±23 years) were included. Median follow-up was 122 (IQR 92–145) months. At diagnosis, 48 patients (40%) already showed advanced vascular damage: occlusions in 38 (32%) involving 62 vessels, aneurysms in 9 (8%) involving 12 vessels, and one dissection (1%). Nineteen (16%) had previously undergone at least one vascular procedure (36 total). GCs were initiated in 112 patients (94%) and permanently discontinued in 41 (34%), after a median of 49 (IQR 49–74) months. No baseline predictors of GC discontinuation were found. csDMARDs were prescribed in 112 patients (94%), mostly at baseline (87%); bDMARDs were prescribed in 85 patients (71%), after a median of 17 (8–51) months, accounting for 151 therapy courses: TNF inhibitors (69%), tocilizumab (23%), JAK inhibitors (5%), and rituximab, ustekinumab, and secukinumab (1% each). During follow-up, 25 patients (21%) developed new arterial occlusions (33 vessels), 7 (6%) new aneurysms (8 vessels), and one patient a new dissection. At least one vascular procedure was performed in 23 patients (19%) for 36 new interventions. Baseline involvement of the abdominal aorta (OR 4.741, 95% CI 1.625–13.833), coeliac trunk (OR 3.054, 95% CI 1.197–7.796), superior mesenteric artery (OR 2.869, 95% CI 1.117–7.369), right renal artery (OR 2.885, 95% CI 1.104–7.539), and left renal artery (OR 5.386, 95% CI 2.023–14.334) predicted future vascular procedures. Infectious complications occurred in 14 patients (12%): 8 bacterial, 2 fungal, 5 mycobacterial; VZV reactivation was reported in 7 (6%). Older age at disease onset was associated with a higher risk of infections (p = 0.003). Other long-term complications included hypertension (13%), ischaemic heart disease (6%), diabetes (3%), osteoporotic fractures (3%), stroke (2%), and pulmonary embolism (2%).

Conclusions. Despite widespread use of biologics, sustained GC withdrawal was achieved in only one-third of patients with TAK, often after prolonged exposure. Vascular procedures remain common, especially in cases with abdominal vessel involvement. Cardiovascular and infectious events, particularly in older patients, are the main long-term complications of TAK.