1568: Comparison of Methotrexate and Azathioprine as the First Steroid-Sparing Immunosuppressive Agent in Patients with Takayasu's Arteritis

Sema Kaymaz-Tahra¹, Ozun Bayindir Tsechelidis², Burak Ince³, Ozlem Ozdemir Isik⁴, Muhammet Emin Kutu⁵, Ozlem Karakas⁶, Tuba Demirci Yildirim⁷, Zeliha Ademoglu⁸, Elif Durak Ediboglu⁹, Burcu Ceren Ekti Uludogan¹⁰, Can Ilgin¹¹, Sule Yasar Bilge¹², Timucin Kasifoğlu¹², Servet Akar⁹, Hakan Emmungil⁸, Fatos Onen¹³, Ahmet Omma⁶, Nilufer Alpay Kanitez¹⁴, Ayten Yazici⁴, Ayse Cefle¹⁵, Murat Inanç¹⁶, Kenan Aksu¹⁷, Gökhan Keser¹⁷, Haner Direskeneli¹⁸ and fatma Alibaz-Öner¹⁹, ¹Sancaktepe Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey, ²Ottawa University, Ottawa, ON, Canada, ³Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey, ⁴Kocaeli University Faculty of Medicine, Kocaeli, Turkey, ⁵Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey, ⁶Ankara City Hospital, Ankara, Turkey, ⁷Dokuz Eylul University, Izmir, Turkey, ⁸Trakya University Faculty of Medicine, Edirne, Turkey, ⁹Katip Celebi University Faculty of Medicine, Izmir, Turkey, ¹⁰Osmangazi University Faculty of Medicine, Eskişehir, Turkey, ¹¹Marmara University Faculty of Medicine, Istanbul, Turkey, ¹²Division of Rheumatology, Medical School, Osmangazi University, Eskişehir, Turkey, ¹³Division of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey, ¹⁴Koc University Faculty of Medicine, Istanbul, Turkey, ¹⁵Division of Rheumatology, Medical School, Kocaeli University, Kocaeli, Turkey, ¹⁶Istanbul University, Istanbul, Turkey, ¹⁷Division of Rheumatology, Medical School, Ege University, Izmir, Turkey, ¹⁸Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey, ¹⁹Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey

Background/Purpose: Conventional disease-modifying anti-rheumatic drugs (cDMARDs) are recommended in addition to glucocorticoids (GC) for all active Takayasu's arteritis (TAK) patients as the first-line therapy. However, there is limited data comparing cDMARDs as the first-line immunosuppressive (IS) treatment. In this study, we aimed to compare the outcomes of methotrexate (MTX) and azathioprine (AZA), which were used most frequently as the first-line cDMARDs, in TAK patients.

Methods: TAK patients who received cDMARDs in addition to GCs as the initial therapy were included in this multicenter retrospective cohort study. Clinical, laboratory and imaging data of the patients were assessed. In addition, a match analysis (cc match) using variables 'age', 'gender' and 'diffuse aortic involvement' was performed between patients who received MTX or AZA as first-line cDMARD treatment.

Results: We included 301 (F/M: 260/41, mean age: 42.2±13.3) patients from 10 centres in the study. As the first-line cDMARD, 204 (67.8%) patients received MTX and 77 (25.6%) patients received AZA. First cDMARD was cyclophosphamide in 17 (5.6%), leflunomide in 2 (0.5%) and mycophenolate mofetil in one patient. The remission, relapse and radiographic progression rates were similar between patients who received MTX and AZA as first-line cDMARDs. Vascular surgery rate was higher in the AZA (23% vs. 9%, p=0.001), whereas the frequency of patients receiving ≤5 mg/day GCs at the end of the follow-up was higher in the MTX group (76 vs 62%, p=0.034). Similarly, the rate of vascular surgery was higher and the GC dose reduction rate (≤5 mg) was lower in AZA group in match analysis. Drug survival was similar between MTX and AZA groups (median 48 months, MTX vs AZA: 32% vs 42%, p=0.34). IS therapy was discontinued in 18 (11 MTX, 7 AZA) patients during the follow-up period due to remission. In the IS discontinuation group 2 patients had a relapse at 2 and 6 months, while 16 patients were still on remission at the end of mean 69.4 (±50.9) months of follow-up.

Conclusion: Remission, relapse, radiographic progression and drug survival rates of azathioprine and methotrexate were similar in Takayasu's arteritis patients having the first-line of therapy. The rate of vascular surgery was higher and the rate of steroid dose reduction was lower with azathioprine compared to methotrexate at the end of the follow-up.






S. Kaymaz-Tahra: None; O. Bayindir Tsechelidis: Janssen, 5; B. Ince: None; O. Isik: None; M. Kutu: None; O. Karakas: None; T. Demirci Yildirim: None; Z. Ademoglu: None; E. Durak Ediboglu: None; B. Ekti Uludogan: None; C. Ilgin: None; S. Yasar Bilge: None; T. Kasifoğlu: None; S. Akar: None; H. Emmungil: None; F. Onen: AbbVie/Abbott, 6, Amgen, 6, Novartis, 6, Pfizer, 6, UCB, 6; A. Omma: None; N. Alpay Kanitez: None; A. Yazici: None; A. Cefle: None; M. Inanç: Boehringer-Ingelheim, 6, Pfizer, 6, UCB, 6; K. Aksu: None; G. Keser: None; H. Direskeneli: AbbVie/Abbott, 1, 5, 6, Amgen, 6, celltrione, 1, 6, Pfizer, 5, 6, Roche, 12, Educational, UCB, 5, 6, 12, Educational; f. Alibaz-Öner: None.