TOPLINE

In patients with Takayasu arteritis, clinical response rates did not differ significantly between those who received TNF inhibitors and those who received tocilizumab, and most patients responded after switching drugs when the first treatment failed. Younger age at symptom onset was associated with response to TNF inhibitors, whereas older age at onset was associated with response to tocilizumab.

METHODOLOGY

• Researchers combined data from two independent cohorts to compare the effectiveness of TNF inhibitors and tocilizumab in patients with Takayasu arteritis and examine whether age at symptom onset was associated with treatment response.
• The analysis included 151 patients from the US National Institutes of Health (NIH; prospective, since 2014) and an Italian hospital (retrospective, 2010-2025). The mean age at symptom onset was 28 years, and 86% of patients were women.
• A total of 129 patients received a TNF inhibitor and 56 received tocilizumab, with the treating physician choosing the drug.
• Clinical response was defined as no clinical signs or symptoms of active vasculitis after at least 6 months of treatment.
• In a prospective subset of 35 patients from the NIH cohort, researchers also tracked physician global assessment, inflammatory markers, and FDG PET scans for up to 24 months. They also compared interleukin-6 and TNF levels in 38 patients and 12 matched healthy individuals.

TAKEAWAY

• Clinical response rates were 72.1% in patients who received TNF inhibitors and 60.7% in those who received tocilizumab, with no significant difference noted between the groups. In the patients followed up prospectively, improvement in physician assessment, inflammatory marker levels, and PET scans also did not differ between the two drugs.
• Among patients whose first treatment failed, 15 of 17 responded after switching from a TNF inhibitor to tocilizumab, and all five responded after switching from tocilizumab to a TNF inhibitor.
• Responders to TNF inhibitors were younger at symptom onset than nonresponders (median age, 23 vs 34 years; P = .0039), whereas responders to tocilizumab were older (median age, 35 vs 21.5 years; P = .0043). In a matched analysis, older age at symptom onset was associated with higher relative odds of response to tocilizumab compared with response to TNF inhibitors (P = .006).
• Patients with symptom onset at 30 years or younger had higher levels of TNF-beta than healthy individuals (P = .04).

IN PRACTICE

"[The] findings argue against a uniform treatment hierarchy and instead support a more individualized approach to biologic selection," the authors of the study wrote.

SOURCE

The study was led by Sreenidhi Sankararaman, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH in Bethesda, Maryland. It was published online on September 28, 2026, in Arthritis Care & Research.

LIMITATIONS

The subset of patients who were followed up prospectively had a modest sample size. Treatments were not assigned in a randomized manner. Detailed blood tests and scans were available only for patients in the NIH group.

DISCLOSURES

The study received support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH. The authors did not report any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.