317. Efficacy and safety of tofacitinib versus leflunomide treatment in Takayasu arteritis: a prospective study
Creators: name: Jinghua Wang1
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background/ Objectives: </strong>Takayasu arteritis (TAK) is a rare large-vessel vasculitis characterized by vascular granulomatous inflammation. Tofacitinib (TOF) is a JAK1/JAK3 signaling pathway inhibitor. In TAK, increasing evidence has suggested that JAK/STAT signaling pathway played an essential role in the pathogenesis of TAK [13, 14]. It has reported that TOF was able to suppress T cells activation and reduce the production of some inflammatory cytokines, such as IFN-γ, IL-17, and IL-21[13]. Thus, this study aimed to compare the effectiveness and safety of TOF with another effective agent, LEF in patients with TAK. <strong>Methods:</strong> A total of 67 patients with active disease screened from the prospective East China Takayasu Arteritis (ECTA) cohort were recruited in this study. Among them, 35 patients were treated with glucocorticoids (GCs) and LEF and 32 patients were treated with GCs and TOF.. The primary endpoint was effectiveness rate (ER) at 6 months. The other aspects were also evaluated, including (1) remission rate: complete remission (CR) and partial remission (PR); (2) relapse rate; (3) reduction in inflammatory parameters (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); (4) vascular imaging changes (vascular improvement, progression or stable vascular lesions); (5) the tapering of GCs dose; (6) side effects. Among them, the rate of relapse and side effects were assessed during a whole period of 12 months. The remaining aspects were all analysed at 6 and 12 months. In addition, treatment effects were also evaluated among naive patients or refractory patients separately between these two groups. <strong>Results:</strong> After 6 months’ treatment, no difference was observed in ER between two groups (LEF group: 31/35 (88.57%) vs. TOF group: 28/32 (87.50%), p=1.00, Figure1 A-B). Differences of CR rate were also not found between these two groups at 6 months and 12 months (6 months: 24/35 (68.57%) vs. 24/32 (75.00%), p=0.60; 12 months: 28/35 (80.00%) vs. 24/32 (75.00%), p=0.77, Figure1 A-B). During 12 months’ treatment, the relapse rate was also comparable between two groups (LEF group: 6 (17.14%) vs. TOF group 7 (21.88%), p=0.76, Figure1 C). However, patients in LEF group achieved longer relapse-free duration than patients in TOF group (11.31±2.83 vs 10.97±1.93 months, p=0.04). ESR and CRP were decreased significantly at 6 (ESR: LEF group: p&lt;0.0001; TOF group: p=0.15; CRP: LEF group: p=0.06; TOF group: p=0.007) and 12 months (ESR: LEF group: p&lt;0.0001; TOF group: p=0.06; CRP: LEF group: p=0.006; TOF group: p=0.14, Figure1 D-E) in both groups compared with their corresponding baseline levels. The proportion of patients with imaging improvement after 12 months’ treatment were low in both groups (LEF group: 1 (2.86%) vs. TOF group: 3 (9.38%) p=0.17). After treatment, the doses of GCs were significantly reduced in both groups from the third month onwards compared with their corresponding baseline dose (p&lt;0.05, Figure1F). Among patients with initial GCs dose ≥ 30mg/day, patients in TOF group gained a much lower daily GCs dose than that of LEF group at 9 months and 12 months (p&lt;0.05, Figure1 H). Furthermore, the frequency of side effects was higher in LEF group than that of TOF group (12/35, 34.29%, vs 3/32, 9.38%; p=0.02). Regarding with subgroup analysis, among naive patients, ESR levels were declined more remarkably in LEF group compared with that of TOF group at 6 and 12 months (P&lt;0.05), while the GCs dose was significantly lower in TOF group after 12 months’ treatment (p&lt;0.05). No differences were observed in ter of treatment effects among refractory patients between two groups (all p&gt;0.05). <strong>Conclusions:</strong> LEF and TOF have comparable treatment effects for patients with TAK. However, TOF is superior to LEF in GCs tapering and safety ile. <strong>Disclosures:</strong> None declared.