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&#40;TNF-&#945;&#41; levels and IL-6 are increased in TA and GCA patients as well&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1&#44;2</span></a> Therefore&#44; blocking TNF-&#945; or IL-6 with biologic therapy &#40;BT&#41; has emerged as an attractive therapeutic alternative that would move the field forward and decrease the cumulative GC toxicity&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Here&#44; we assessed the clinical&#44; serological&#44; and imaging outcomes of 10 patients with refractory TA and GCA who were administered BT&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Inclusion of patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients with GCA or TA &#40;ACR&#44; 1990&#41; under BT were retrospectively identified from our medical records&#46; All cases were refractory to conventional therapies including GC&#44; or had developed significant adverse effects from these agents&#46; Our hospital ethics committee approved the off-label use of infliximab &#40;IFX&#41;&#44; etanercept &#40;ETN&#41; or tocilizumab &#40;TCZ&#41; for these patients&#44; and informed consent was obtained from the patients or their relatives after thorough discussion on the risk&#47;benefit ratio of BT&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Clinical data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The following patient information was recorded&#58; sex&#44; age&#44; disease duration&#44; prior and concomitant immunomodulatory treatment&#44; reason for starting BT&#44; acute phase reactants &#91;erythrocyte sedimentation rate &#40;mm&#47;h&#41; and C-reactive protein &#40;mg&#47;L&#41;&#93;&#44; type and dose of BT used&#44; clinical response at 3&#44; 6&#44; 12&#44; 24 months and last follow-up&#44; follow-up time&#44; imaging when available&#44; revascularization procedures and relevant AEs secondary to BT&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Disease activity assessment</span><p id="par0035" class="elsevierStylePara elsevierViewall">In TA&#44; disease activity was assessed according to previously published criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> In GCA&#44; active disease was defined as worsening or emergence of &#8805;2 of the following&#58; &#40;1&#41; fever or other characteristic of systemic involvement &#40;in the absence of another cause&#41;&#59; &#40;2&#41; increased ESR and&#47;or C-reactive protein &#40;CRP&#41;&#59; &#40;3&#41; clinical manifestation secondary to large vessel involvement and &#40;4&#41; symptoms consistent with polymyalgia rheumatica &#40;PMR&#41;&#46; In case of no active disease&#44; the patient was considered in remission&#46; Sustained remission was defined in those who met these conditions for at least 6 months while receiving less than 10<span class="elsevierStyleHsp" style=""></span>mg&#47;day of prednisone&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Imaging procedures</span><p id="par0040" class="elsevierStylePara elsevierViewall">In TA&#44; magnetic resonance angiography &#40;MRA&#41; was performed in all patients either initially for confirming the initial diagnosis or at a later time for planning surgical procedures&#46; MRA was also used even in the absence of new symptoms or findings&#44; to monitor the activity and distribution of lesions&#46; Each study included the entire aorta and all primary branch vessels&#46; Active or relapsing disease was considered to be present in the setting of new vascular lesions&#44; as visualized by MRA&#44; at sites that were previously unaffected&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">The data are reported using descriptive statistics&#46; Numerical data are expressed as mean and standard deviation &#40;SD&#41; for continuous variables and percentages for qualitative variables&#46; The ESR and CRP monitoring represent the mean &#40;&#177;SD&#41; of the sum of the individual values of different visits after starting BT&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Ten patients&#44; 5 with TA and 5 with GCA under BT were included&#46; Demographics and baseline ESR&#44; CRP and GC dose are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In TA&#44; the most common lesion sites were supra-aortic arteries &#40;in all cases&#41;&#46; Abdominal aorta and its branches were affected in three patients but only 2 patients showed thoracic aorta involvement&#46; Stenotic lesions were the most frequent vascular finding and only one patient presented with aneurismal lesions&#46; Three patients required revascularization procedures prior to BT&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The main reason for starting BT in TA was the appearance of relapses upon GC tapering in all patients and lack of response to prior therapy&#59; methotrexate &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; cyclophosphamide &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; and mycophenolate mofetil &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; were the most common IS agents added at some point to GC&#46; One patient had received adalimumab prior to this study but remission was not achieved and BT was switched to TCZ&#46; Four patients received IFX and 1 patient TCZ&#46; Only one patient received IFX as monotherapy &#40;patient 5&#41; and the remaining four received methotrexate &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; 20&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;week &#40;2 subcutaneous and 2 oral administration&#41; or mycophenolate mofetil &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; 1000<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46; Remission was observed before 6 months in all cases&#46; Sustained remission was achieved in all cases during follow-up &#40;mean follow-up 59&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;2 months&#41; and GC daily dose was reduced by 79&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In cases of sustained remission&#44; careful down-titration was carried out without evidence of relapses&#46; None of the patients developed a new arterial lesion while receiving BT&#46; Furthermore&#44; revascularization procedures were not required during follow-up&#46; All patients tolerated BT without infusion reactions&#46; Other AEs attributable to BT were recurrent infections &#40;one patient with IFX&#41; and mild neutropenia &#40;one patient with TCZ&#41;&#46; At last follow-up&#44; 3 patients continued on BT&#44; 1 patient was lost to follow up &#40;moved to another country&#41; and 1 patient discontinued IFX due to recurrent infections&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In GCA the main reason for starting BT was lack of response to prior therapy &#40;MTX in 5 patients&#44; AZA in 2 patients&#44; MMF in 2 patients&#41; and&#47;or &#8805;2 relapses during GC tapering&#46; Three patients started TCZ&#44; one patient IFX and one patient ETN&#46; Three patients received BT as monotherapy &#40;patients 6&#8211;8&#41; and the remaining two received MTX 15<span class="elsevierStyleHsp" style=""></span>mg&#47;week and leflunomide 20<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46; The remission was observed before 3 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41; and 6 months &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Only one patient had a relapse during follow-up &#40;mean follow-up 37&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&#46;8 months&#41;&#46; This was the patient under ETN therapy who suffered a recurrence at 24 months of BT and six months after GC withdrawal&#46; She presented with PMR&#44; high CRP and ESR without any ischemic complication and resolved with GC reintroduction&#46; Overall&#44; the daily dose of GC in GCA was reduced by 60&#37;&#46; No changes in concomitant IS agents was required&#46; One AE was attributable to IFX &#40;anaphylaxis&#41; and 1 AE attributable to TCZ &#40;mild neutropenia&#41;&#46; At last follow-up&#44; 2 patients continued with BT&#44; 1 patient discontinued ETN for sustained remission&#44; 1 patient discontinued BT secondary to AE attributable to IFX and 1 patient died for reasons not attributable to BT&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">There are no reported randomized controlled studies on the use of BT in TA&#46; Hoffman et al&#46; first published an open-label trial of anti-TNF therapy in TA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; in 2004&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> Overall&#44; the addition of anti-TNF therapy resulted in improvement in 14 patients and sustained remission in 10 cases&#46; Anti-TNF treatment also allowed for the reduction or elimination of GC therapy in almost all of the patients&#46; In 2008&#44; Molloy et al&#46; published their experience in 25 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> Following anti-TNF therapy&#44; remission was achieved and prednisone was discontinued in 15 patients &#40;60&#37;&#41; and successfully tapered below 10<span class="elsevierStyleHsp" style=""></span>mg&#47;day in additional 7 patients &#40;28&#37;&#41;&#46; Schmidt et al&#46; reported in 2012 a single center experience with the use of TNF inhibitors in 20 patients with TA&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> Disease remission was achieved in 18 &#40;90&#37;&#41; but 33&#37; of patients experienced disease relapse while receiving BT&#46; In France&#44; Mekinian et al&#46; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; confirmed also previous reports on the efficacy of TNF inhibitors in refractory TA&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">TCZ could be another option for refractory TA or patients failing to TNF-inhibitors&#46; Abisror et al&#46; retrospectively studied 5 patients from 3 French university hospitals and 39 cases from the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> Clinical and biological activities significantly decreased within 3 months similarly to steroid dose and steroid-dependence rate&#46; Remission was achieved in 33 cases &#40;75&#37;&#41;&#46; Moreover&#44; 9 out of 14 patients &#40;65&#37;&#41; who had previously received TNF inhibitors achieved remission&#46; Recently&#44; Ca&#241;as et al&#46; reported 8 refractory TA patients treated with TCZ who achieved remission in all cases and 85&#37; GC reduction&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> Last&#44; Loricera et al&#46; published a study on 16 patients with inflammatory aortitis refractory to corticosteroids or to other biologic immunosuppressive drugs &#40;14 cases were large vessels vasculitis&#41;&#44; TCZ appeared to be effective and relatively safe&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> Most recently&#44; the same study group evaluated the efficacy of TCZ in patients with refractory TA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#46; Clinical and laboratory parameters improved in most cases&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> Both TCZ and TNF inhibitors seem to be effective in refractory TA but comparative studies to determine the better strategy for these biologics are lacking&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Despite the reported experience in TA with BT and the lack of clinical trials&#44; GCA first published randomized trial was terminated prematurely due to lack of benefit with IFX&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> However&#44; the protocol of steroid tapering used in this study could have negatively influenced the final results&#46; Two subsequent controlled trials failed to demonstrate a steroid sparing effect of etanercept and adalimumab&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">13&#44;14</span></a> However&#44; the response in 2 of our patients suggests a potential role for these therapies in selected GC refractory cases&#46; Regarding TCZ&#44; our findings are in agreement with a recently published systematic review and meta-analysis of GCA patients treated with TCZ&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> All the 19 patients treated with TCZ plus prednisone achieved disease remission and a steroid sparing effect with complete discontinuation of GC in nine patients&#46; Notably&#44; 3 of our patients with GCA were successfully treated with TCZ monotherapy&#46; Finally&#44; TCZ therapy showed rapid and maintained improvement in patients with refractory GCA and&#47;or with unacceptable AEs related to GCs in a multicenter open-label study of 22 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In spite of the limitations of a retrospective study and the small number of patients included&#44; our data provide positive evidence on the potential benefit of TNF inhibitors and TCZ in patients with large vessels vasculitis refractory to conventional treatment&#46; TNF inhibitors or TCZ have a role as steroid-sparing agents in refractory LVV patients&#44; with acceptable safety profile&#46; TCZ might be the first choice biologic therapy in refractory GCA patients&#46; In the absence of randomized controlled trials addressing this specific clinical situation&#44; this type of evidence can help in our daily clinical practice&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Ethical disclosures</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Protection of human and animal subjects</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Confidentiality of data</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Right to privacy and informed consent</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">This research received no specific grant from any funding agency in the public&#44; commercial&#44; or not for-profit sectors&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">RGV has received funding for research or teaching from MSD&#44; Roche&#44; BMS&#44; Abbvie&#44; and UCB&#59; has participated on advisory boards for Actelion&#44; BMS&#44; UCB&#44; Pfizer&#44; Roche&#44; Hospira&#44; Janssen and Sandoz&#44; has delivered presentations sponsored by Roche&#44; BMS&#44; Pfizer&#44; UCB&#44; Sandoz&#46;</p></span></span>"
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    "fechaRecibido" => "2016-03-09"
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            0 => "Biological therapy"
            1 => "Takayasu arteritis"
            2 => "Giant cell arteritis"
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            4 => "Etanercept"
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            0 => "Terapia biol&#243;gica"
            1 => "Arteritis de Takayasu"
            2 => "Arteritis de c&#233;lulas gigantes"
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            4 => "Etanercept"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the results obtained in clinical practice with the use of biological therapy &#40;BT&#41; in patients diagnosed with Takayasu arteritis &#40;TA&#41; and giant cell arteritis &#40;GCA&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective single center study of TA&#47;GCA patients who received BT &#40;infliximab &#91;IFX&#93;&#44; etanercept &#91;ETN&#93; and tocilizumab &#91;TCZ&#93;&#41;&#46; In TA&#44; active disease was defined according to a previous National Institutes of Health study&#46; In GCA&#44; active disease was defined with a modified criteria and clinical manifestations secondary to temporal artery involvement or polymyalgia rheumatica symptoms&#46; Clinical data and outcomes are reported using descriptive statistics&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Five patients with TA and 5 with GCA were included&#46; The main reason for starting BT was lack of response to prior therapy and&#47;or &#8805;2 relapses during GC tapering&#46; Five patients started IFX&#44; four TCZ and 1 ETN&#46; Remission was observed before 6 months in all cases&#46; Only one patient had a relapse during long-term follow-up and the overall GC daily dose was reduced by 70&#37;&#46; Two AEs were considered attributable to IFX and one to TCZ&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A favorable and sustained response to BT was observed in our patients with TA and GCA&#46; Thus&#44; BT might be considered as an alternative in patients with large vessel arteritis refractory to conventional treatment or with GC related comorbidities&#46;</p></span>"
        "secciones" => array:4 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir los resultados obtenidos en la pr&#225;ctica cl&#237;nica diaria con el uso de la terapia biol&#243;gica &#40;TB&#41; en pacientes con diagn&#243;stico de arteritis de Takayasu &#40;AT&#41; y arteritis de c&#233;lulas gigantes &#40;ACG&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo monoc&#233;ntrico de pacientes con AT&#47;ACG que recibieron TB &#40;infliximab&#44; etanercept y tocilizumab&#41;&#46; En AT&#44; la enfermedad activa se defini&#243; de acuerdo a un estudio previo del National Institutes of Health&#46; En ACG&#44; la enfermedad activa se defini&#243; con dichos criterios modificados y manifestaciones cl&#237;nicas secundarias a afectaci&#243;n de la arteria temporal o s&#237;ntomas de polimialgia reum&#225;tica&#46; Los datos y los desenlaces cl&#237;nicos se muestran mediante estad&#237;stica descriptiva&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 5 pacientes con AT y 5 con ACG&#46; La raz&#243;n principal para el inicio de la TB fue la falta de respuesta al tratamiento previo y&#47;o &#8805;<span class="elsevierStyleHsp" style=""></span>2 reca&#237;das durante la terapia con corticoides&#46; Cinco pacientes comenzaron infliximab&#44; 4 tocilizumab y uno etanercept&#46; La remisi&#243;n se observ&#243; antes de los 6 meses en todos los casos&#46; Solo un paciente tuvo una reca&#237;da durante el seguimiento a largo plazo&#46; La dosis diaria de corticoides se redujo globalmente en un 70&#37;&#46; Dos acontecimientos adversos se consideraron atribuibles a infliximab y uno a tocilizumab&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se observ&#243; una respuesta favorable y sostenida a la TB en nuestros pacientes con AT y ACG&#46; Por lo tanto&#44; la TB puede ser considerada una alternativa en pacientes refractarios al tratamiento convencional o con comorbilidades asociadas a los corticoides&#46;</p></span>"
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            "titulo" => "Objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "multimedia" => array:1 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; <span class="elsevierStyleItalic">n</span>&#44; number of patient&#59; TA&#44; Takayasu arteritis&#59; GCA&#44; giant cell arteritis&#59; F&#44; female&#59; M&#44; male&#59; IFX&#44; infliximab TCZ&#44; tocilizumab&#59; ETN&#44; etanercept&#59; ESR&#44; erythrocyte sedimentation rate &#40;mm&#47;1<span class="elsevierStyleHsp" style=""></span>hour&#41;&#59; CRP&#44; C-reactive protein &#40;mg&#47;L&#41;&#46; Acute phase reactants are expressed as mean of overall monitoring<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of Disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Biological Therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline PREDNISONE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline ESR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline CRP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PREDNISONE&#44; last follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ESR mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CRP mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IFX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TCZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IFX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IFX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IFX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TCZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TCZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IFX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ETN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>mg&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TCZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Baseline clinical characteristics &#91;prednisone dose&#44; acute phase reactants and response obtained after biological therapy &#40;BT&#41;&#93; in Takayasu arteritis and giant cell arteritis patients&#46;</p>"
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Brief report
Sustained remission after long-term biological therapy in patients with large vessel vasculitis: an analysis of ten cases
Remisión sostenida tras terapia biológica en pacientes con vasculitis de grandes vasos: análisis de 10 casos
Juan P. Vinickia,
Corresponding author
jpvinicki@hotmail.com

Corresponding author.
, Rosario García-Vicuñab, Miguel Arredondoa, Juan P. López-Boteb, Jesús A. García-Vadillob, Santos Castañedab, José M. Álvaro-Graciaa,b
a Unidad de Terapias Biológicas, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
b Servicio de Reumatología, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
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          0 => array:3 [
            "entidad" => "Unidad de Terapias Biol&#243;gicas&#44; Hospital Universitario de La Princesa&#44; IIS-IP&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital Universitario de La Princesa&#44; IIS-IP&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Remisi&#243;n sostenida tras terapia biol&#243;gica en pacientes con vasculitis de grandes vasos&#58; an&#225;lisis de 10 casos"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Giant cell arteritis &#40;GCA&#41; and Takayasu arteritis &#40;TA&#41; are chronic inflammatory diseases that mainly affect large elastic arteries&#46; Although GCA is a disease of older people and TA is a disease of younger people&#44; their shared predilection for causing vasculitis of large arteries and their nearly identical histopathologic changes suggest a possible link in pathophysiology and eventually in treatment response&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Response to glucocorticoids &#40;GCs&#41; is generally favorable in GCA and TA but relapses may occur while gradually tapering GCs&#46; Physicians tend to start immunosuppressive &#40;IS&#41; agents together with GCs but there is no evidence showing which is the IS agent of choice&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Serum tumor necrosis factor-&#945; &#40;TNF-&#945;&#41; levels and IL-6 are increased in TA and GCA patients as well&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1&#44;2</span></a> Therefore&#44; blocking TNF-&#945; or IL-6 with biologic therapy &#40;BT&#41; has emerged as an attractive therapeutic alternative that would move the field forward and decrease the cumulative GC toxicity&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Here&#44; we assessed the clinical&#44; serological&#44; and imaging outcomes of 10 patients with refractory TA and GCA who were administered BT&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Inclusion of patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients with GCA or TA &#40;ACR&#44; 1990&#41; under BT were retrospectively identified from our medical records&#46; All cases were refractory to conventional therapies including GC&#44; or had developed significant adverse effects from these agents&#46; Our hospital ethics committee approved the off-label use of infliximab &#40;IFX&#41;&#44; etanercept &#40;ETN&#41; or tocilizumab &#40;TCZ&#41; for these patients&#44; and informed consent was obtained from the patients or their relatives after thorough discussion on the risk&#47;benefit ratio of BT&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Clinical data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The following patient information was recorded&#58; sex&#44; age&#44; disease duration&#44; prior and concomitant immunomodulatory treatment&#44; reason for starting BT&#44; acute phase reactants &#91;erythrocyte sedimentation rate &#40;mm&#47;h&#41; and C-reactive protein &#40;mg&#47;L&#41;&#93;&#44; type and dose of BT used&#44; clinical response at 3&#44; 6&#44; 12&#44; 24 months and last follow-up&#44; follow-up time&#44; imaging when available&#44; revascularization procedures and relevant AEs secondary to BT&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Disease activity assessment</span><p id="par0035" class="elsevierStylePara elsevierViewall">In TA&#44; disease activity was assessed according to previously published criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> In GCA&#44; active disease was defined as worsening or emergence of &#8805;2 of the following&#58; &#40;1&#41; fever or other characteristic of systemic involvement &#40;in the absence of another cause&#41;&#59; &#40;2&#41; increased ESR and&#47;or C-reactive protein &#40;CRP&#41;&#59; &#40;3&#41; clinical manifestation secondary to large vessel involvement and &#40;4&#41; symptoms consistent with polymyalgia rheumatica &#40;PMR&#41;&#46; In case of no active disease&#44; the patient was considered in remission&#46; Sustained remission was defined in those who met these conditions for at least 6 months while receiving less than 10<span class="elsevierStyleHsp" style=""></span>mg&#47;day of prednisone&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Imaging procedures</span><p id="par0040" class="elsevierStylePara elsevierViewall">In TA&#44; magnetic resonance angiography &#40;MRA&#41; was performed in all patients either initially for confirming the initial diagnosis or at a later time for planning surgical procedures&#46; MRA was also used even in the absence of new symptoms or findings&#44; to monitor the activity and distribution of lesions&#46; Each study included the entire aorta and all primary branch vessels&#46; Active or relapsing disease was considered to be present in the setting of new vascular lesions&#44; as visualized by MRA&#44; at sites that were previously unaffected&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">The data are reported using descriptive statistics&#46; Numerical data are expressed as mean and standard deviation &#40;SD&#41; for continuous variables and percentages for qualitative variables&#46; The ESR and CRP monitoring represent the mean &#40;&#177;SD&#41; of the sum of the individual values of different visits after starting BT&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Ten patients&#44; 5 with TA and 5 with GCA under BT were included&#46; Demographics and baseline ESR&#44; CRP and GC dose are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In TA&#44; the most common lesion sites were supra-aortic arteries &#40;in all cases&#41;&#46; Abdominal aorta and its branches were affected in three patients but only 2 patients showed thoracic aorta involvement&#46; Stenotic lesions were the most frequent vascular finding and only one patient presented with aneurismal lesions&#46; Three patients required revascularization procedures prior to BT&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The main reason for starting BT in TA was the appearance of relapses upon GC tapering in all patients and lack of response to prior therapy&#59; methotrexate &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; cyclophosphamide &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; and mycophenolate mofetil &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; were the most common IS agents added at some point to GC&#46; One patient had received adalimumab prior to this study but remission was not achieved and BT was switched to TCZ&#46; Four patients received IFX and 1 patient TCZ&#46; Only one patient received IFX as monotherapy &#40;patient 5&#41; and the remaining four received methotrexate &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; 20&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;week &#40;2 subcutaneous and 2 oral administration&#41; or mycophenolate mofetil &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; 1000<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46; Remission was observed before 6 months in all cases&#46; Sustained remission was achieved in all cases during follow-up &#40;mean follow-up 59&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;2 months&#41; and GC daily dose was reduced by 79&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In cases of sustained remission&#44; careful down-titration was carried out without evidence of relapses&#46; None of the patients developed a new arterial lesion while receiving BT&#46; Furthermore&#44; revascularization procedures were not required during follow-up&#46; All patients tolerated BT without infusion reactions&#46; Other AEs attributable to BT were recurrent infections &#40;one patient with IFX&#41; and mild neutropenia &#40;one patient with TCZ&#41;&#46; At last follow-up&#44; 3 patients continued on BT&#44; 1 patient was lost to follow up &#40;moved to another country&#41; and 1 patient discontinued IFX due to recurrent infections&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In GCA the main reason for starting BT was lack of response to prior therapy &#40;MTX in 5 patients&#44; AZA in 2 patients&#44; MMF in 2 patients&#41; and&#47;or &#8805;2 relapses during GC tapering&#46; Three patients started TCZ&#44; one patient IFX and one patient ETN&#46; Three patients received BT as monotherapy &#40;patients 6&#8211;8&#41; and the remaining two received MTX 15<span class="elsevierStyleHsp" style=""></span>mg&#47;week and leflunomide 20<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46; The remission was observed before 3 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41; and 6 months &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Only one patient had a relapse during follow-up &#40;mean follow-up 37&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&#46;8 months&#41;&#46; This was the patient under ETN therapy who suffered a recurrence at 24 months of BT and six months after GC withdrawal&#46; She presented with PMR&#44; high CRP and ESR without any ischemic complication and resolved with GC reintroduction&#46; Overall&#44; the daily dose of GC in GCA was reduced by 60&#37;&#46; No changes in concomitant IS agents was required&#46; One AE was attributable to IFX &#40;anaphylaxis&#41; and 1 AE attributable to TCZ &#40;mild neutropenia&#41;&#46; At last follow-up&#44; 2 patients continued with BT&#44; 1 patient discontinued ETN for sustained remission&#44; 1 patient discontinued BT secondary to AE attributable to IFX and 1 patient died for reasons not attributable to BT&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">There are no reported randomized controlled studies on the use of BT in TA&#46; Hoffman et al&#46; first published an open-label trial of anti-TNF therapy in TA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; in 2004&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> Overall&#44; the addition of anti-TNF therapy resulted in improvement in 14 patients and sustained remission in 10 cases&#46; Anti-TNF treatment also allowed for the reduction or elimination of GC therapy in almost all of the patients&#46; In 2008&#44; Molloy et al&#46; published their experience in 25 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> Following anti-TNF therapy&#44; remission was achieved and prednisone was discontinued in 15 patients &#40;60&#37;&#41; and successfully tapered below 10<span class="elsevierStyleHsp" style=""></span>mg&#47;day in additional 7 patients &#40;28&#37;&#41;&#46; Schmidt et al&#46; reported in 2012 a single center experience with the use of TNF inhibitors in 20 patients with TA&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> Disease remission was achieved in 18 &#40;90&#37;&#41; but 33&#37; of patients experienced disease relapse while receiving BT&#46; In France&#44; Mekinian et al&#46; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; confirmed also previous reports on the efficacy of TNF inhibitors in refractory TA&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">TCZ could be another option for refractory TA or patients failing to TNF-inhibitors&#46; Abisror et al&#46; retrospectively studied 5 patients from 3 French university hospitals and 39 cases from the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> Clinical and biological activities significantly decreased within 3 months similarly to steroid dose and steroid-dependence rate&#46; Remission was achieved in 33 cases &#40;75&#37;&#41;&#46; Moreover&#44; 9 out of 14 patients &#40;65&#37;&#41; who had previously received TNF inhibitors achieved remission&#46; Recently&#44; Ca&#241;as et al&#46; reported 8 refractory TA patients treated with TCZ who achieved remission in all cases and 85&#37; GC reduction&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> Last&#44; Loricera et al&#46; published a study on 16 patients with inflammatory aortitis refractory to corticosteroids or to other biologic immunosuppressive drugs &#40;14 cases were large vessels vasculitis&#41;&#44; TCZ appeared to be effective and relatively safe&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> Most recently&#44; the same study group evaluated the efficacy of TCZ in patients with refractory TA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#46; Clinical and laboratory parameters improved in most cases&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> Both TCZ and TNF inhibitors seem to be effective in refractory TA but comparative studies to determine the better strategy for these biologics are lacking&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Despite the reported experience in TA with BT and the lack of clinical trials&#44; GCA first published randomized trial was terminated prematurely due to lack of benefit with IFX&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> However&#44; the protocol of steroid tapering used in this study could have negatively influenced the final results&#46; Two subsequent controlled trials failed to demonstrate a steroid sparing effect of etanercept and adalimumab&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">13&#44;14</span></a> However&#44; the response in 2 of our patients suggests a potential role for these therapies in selected GC refractory cases&#46; Regarding TCZ&#44; our findings are in agreement with a recently published systematic review and meta-analysis of GCA patients treated with TCZ&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> All the 19 patients treated with TCZ plus prednisone achieved disease remission and a steroid sparing effect with complete discontinuation of GC in nine patients&#46; Notably&#44; 3 of our patients with GCA were successfully treated with TCZ monotherapy&#46; Finally&#44; TCZ therapy showed rapid and maintained improvement in patients with refractory GCA and&#47;or with unacceptable AEs related to GCs in a multicenter open-label study of 22 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In spite of the limitations of a retrospective study and the small number of patients included&#44; our data provide positive evidence on the potential benefit of TNF inhibitors and TCZ in patients with large vessels vasculitis refractory to conventional treatment&#46; TNF inhibitors or TCZ have a role as steroid-sparing agents in refractory LVV patients&#44; with acceptable safety profile&#46; TCZ might be the first choice biologic therapy in refractory GCA patients&#46; In the absence of randomized controlled trials addressing this specific clinical situation&#44; this type of evidence can help in our daily clinical practice&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Ethical disclosures</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Protection of human and animal subjects</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Confidentiality of data</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Right to privacy and informed consent</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">This research received no specific grant from any funding agency in the public&#44; commercial&#44; or not for-profit sectors&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">RGV has received funding for research or teaching from MSD&#44; Roche&#44; BMS&#44; Abbvie&#44; and UCB&#59; has participated on advisory boards for Actelion&#44; BMS&#44; UCB&#44; Pfizer&#44; Roche&#44; Hospira&#44; Janssen and Sandoz&#44; has delivered presentations sponsored by Roche&#44; BMS&#44; Pfizer&#44; UCB&#44; Sandoz&#46;</p></span></span>"
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              "titulo" => "M&#233;todos"
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          "titulo" => "Introduction"
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              "titulo" => "Clinical data"
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            2 => array:2 [
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              "titulo" => "Disease activity assessment"
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            3 => array:2 [
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              "titulo" => "Imaging procedures"
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              "titulo" => "Protection of human and animal subjects"
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              "titulo" => "Confidentiality of data"
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            2 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Right to privacy and informed consent"
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        9 => array:2 [
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          "titulo" => "Funding"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2016-03-09"
    "fechaAceptado" => "2016-06-23"
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          "titulo" => "Keywords"
          "identificador" => "xpalclavsec853919"
          "palabras" => array:6 [
            0 => "Biological therapy"
            1 => "Takayasu arteritis"
            2 => "Giant cell arteritis"
            3 => "Infliximab"
            4 => "Etanercept"
            5 => "Tocilizumab"
          ]
        ]
      ]
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          "palabras" => array:6 [
            0 => "Terapia biol&#243;gica"
            1 => "Arteritis de Takayasu"
            2 => "Arteritis de c&#233;lulas gigantes"
            3 => "Infliximab"
            4 => "Etanercept"
            5 => "Tocilizumab"
          ]
        ]
      ]
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the results obtained in clinical practice with the use of biological therapy &#40;BT&#41; in patients diagnosed with Takayasu arteritis &#40;TA&#41; and giant cell arteritis &#40;GCA&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective single center study of TA&#47;GCA patients who received BT &#40;infliximab &#91;IFX&#93;&#44; etanercept &#91;ETN&#93; and tocilizumab &#91;TCZ&#93;&#41;&#46; In TA&#44; active disease was defined according to a previous National Institutes of Health study&#46; In GCA&#44; active disease was defined with a modified criteria and clinical manifestations secondary to temporal artery involvement or polymyalgia rheumatica symptoms&#46; Clinical data and outcomes are reported using descriptive statistics&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Five patients with TA and 5 with GCA were included&#46; The main reason for starting BT was lack of response to prior therapy and&#47;or &#8805;2 relapses during GC tapering&#46; Five patients started IFX&#44; four TCZ and 1 ETN&#46; Remission was observed before 6 months in all cases&#46; Only one patient had a relapse during long-term follow-up and the overall GC daily dose was reduced by 70&#37;&#46; Two AEs were considered attributable to IFX and one to TCZ&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A favorable and sustained response to BT was observed in our patients with TA and GCA&#46; Thus&#44; BT might be considered as an alternative in patients with large vessel arteritis refractory to conventional treatment or with GC related comorbidities&#46;</p></span>"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir los resultados obtenidos en la pr&#225;ctica cl&#237;nica diaria con el uso de la terapia biol&#243;gica &#40;TB&#41; en pacientes con diagn&#243;stico de arteritis de Takayasu &#40;AT&#41; y arteritis de c&#233;lulas gigantes &#40;ACG&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo monoc&#233;ntrico de pacientes con AT&#47;ACG que recibieron TB &#40;infliximab&#44; etanercept y tocilizumab&#41;&#46; En AT&#44; la enfermedad activa se defini&#243; de acuerdo a un estudio previo del National Institutes of Health&#46; En ACG&#44; la enfermedad activa se defini&#243; con dichos criterios modificados y manifestaciones cl&#237;nicas secundarias a afectaci&#243;n de la arteria temporal o s&#237;ntomas de polimialgia reum&#225;tica&#46; Los datos y los desenlaces cl&#237;nicos se muestran mediante estad&#237;stica descriptiva&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 5 pacientes con AT y 5 con ACG&#46; La raz&#243;n principal para el inicio de la TB fue la falta de respuesta al tratamiento previo y&#47;o &#8805;<span class="elsevierStyleHsp" style=""></span>2 reca&#237;das durante la terapia con corticoides&#46; Cinco pacientes comenzaron infliximab&#44; 4 tocilizumab y uno etanercept&#46; La remisi&#243;n se observ&#243; antes de los 6 meses en todos los casos&#46; Solo un paciente tuvo una reca&#237;da durante el seguimiento a largo plazo&#46; La dosis diaria de corticoides se redujo globalmente en un 70&#37;&#46; Dos acontecimientos adversos se consideraron atribuibles a infliximab y uno a tocilizumab&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se observ&#243; una respuesta favorable y sostenida a la TB en nuestros pacientes con AT y ACG&#46; Por lo tanto&#44; la TB puede ser considerada una alternativa en pacientes refractarios al tratamiento convencional o con comorbilidades asociadas a los corticoides&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "multimedia" => array:1 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; <span class="elsevierStyleItalic">n</span>&#44; number of patient&#59; TA&#44; Takayasu arteritis&#59; GCA&#44; giant cell arteritis&#59; F&#44; female&#59; M&#44; male&#59; IFX&#44; infliximab TCZ&#44; tocilizumab&#59; ETN&#44; etanercept&#59; ESR&#44; erythrocyte sedimentation rate &#40;mm&#47;1<span class="elsevierStyleHsp" style=""></span>hour&#41;&#59; CRP&#44; C-reactive protein &#40;mg&#47;L&#41;&#46; Acute phase reactants are expressed as mean of overall monitoring<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of Disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Biological Therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline PREDNISONE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline ESR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline CRP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PREDNISONE&#44; last follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ESR mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CRP mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IFX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TCZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IFX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IFX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IFX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TCZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TCZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IFX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;8 weeks&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>mg&#47;week&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Baseline clinical characteristics &#91;prednisone dose&#44; acute phase reactants and response obtained after biological therapy &#40;BT&#41;&#93; in Takayasu arteritis and giant cell arteritis patients&#46;</p>"
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Article information
ISSN: 21735743
Original language: English
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