Common autoimmune drug that helps patients with giant cell arteritis

Common autoimmune drug that helps patients with giant cell arteritis

A common drug that has already been used for autoimmune diseases such as rheumatoid arthritisNew England Journal of Medicine.Giant cell arteritis causes the body's immune system to attack blood vessels in the head, neck and other areas, and often leads to headaches, vision loss and even aortic aneurysms. However, nearly half of patients who took upadacitinib in a new phase 3 clinical trial achieved sustained remission and reduced their dependence on glucocorticoids (typically called "steroids"), the most common treatment.For comparison: Less than 30 percent of patients who took a placebo achieved remission.

The side effects of glucocorticoid treatment often greatly affect most patients with giant cell arteritis. Having the opportunity to use upadacitinib for this disease is a big win as it could help patients stop taking glucocorticoids, control their disease and improve their quality of life. “

Peter A. Merkel, MD, MPH,Senior Author,Chief of Rheumatology, Professor of Rheumatology and Epidemiology and Director of the Penn Vasculitis Center

An attractive target

The main current treatment for giant cell arteritis involves daily use of glucocorticoids, particularly prednisone. Unfortunately, glucocorticoids can affect patients with serious side effects such as weight gain, diabetes, osteoporosis, high blood pressure and infections.

However, because researchers have already determined that a cellular communication pathway called the JAK-Stat signaling pathway plays a significant role in giant cell arteritis, it shows an alternative treatment target, particularly for Janus kinase (JAK) inhibitors, which can block interleukin-6, interferon-y and other proteins that produce cytokines critical to inflammation.

Sustained remission

The new study included 100 sites in 24 countries. Patients with giant cell arteritis treated with daily prednisone were randomized into one of three different groups: the control group, which received placebo medication; a group that received 7.5 milligrams of upadacitinib daily; and a group that received 15 milligrams of upadacitinib daily. All groups were expected to slowly but completely reduce their prednisone use: by week 52 for the placebo group and week 26 for the upadacitinib groups.

At the end of their participation in the year-long study, 46 percent of the higher dose upadacitinib achieved sustained remission, meaning they had no signs or symptoms of giant cell arteritis between weeks 12 and 52, a clinically and statistically significant benefit. This was compared to 29 percent for the placebo group that achieved remission. In the lower-dose upadacitinib group, 41 percent achieved remission, but this was not statistically significantly different from the placebo group.

Security measures also excellent

In addition to measuring remission, the study's researchers also looked at some secondary effects of taking upadacitinib, including how long a remission lasted, how long it took for symptoms to relapse, and how much prednisone the patients had taken overall. In these measures, the higher dose of upadacitinib was superior to or equal to placebo.

When researchers looked at safety measures, upadacitinib was equal to placebo, meaning it did not confer any additional harm to patients, such as side effects or worse.

This study was funded by Abbvie, which makes a branded version of upadacitinib.

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