Giant cell arteritis and Takayasu arteritis are the two major forms of 
idiopathic large vessel vasculitis. High doses of glucocorticoids are effective 
in inducing remission in both conditions, but relapses and recurrences are 
common, requiring prolonged glucocorticoid treatment with the risk of the 
related adverse events. Areas covered: In this article, we will review the 
standard and biological treatment strategies in large vessel vasculitis, and we 
will focus on the current approaches to these diseases. Expert commentary: The 
results of treatment trials with conventional immunosuppressive agents such as 
methotrexate, azathioprine, mycophenolate mofetil, and cyclophosphamide have 
overall been disappointing. TNF-α blockers are ineffective in giant cell 
arteritis, while observational evidence and a phase 2 randomized trial support 
the use of tocilizumab in relapsing giant cell arteritis. Observational evidence 
strongly supports the use of anti-TNF-α agents and tocilizumab in Takayasu 
patients with relapsing disease. However biological agents are not curative, and 
relapses remain common.