Disease-modifying anti-rheumatic drugs for the management of Takayasu arteritis—a systematic review and meta-analysis
Top Cited Papers
- 1 May 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in Clinical Rheumatology
- Vol. 40 (11), 4391-4416
- https://doi.org/10.1007/s10067-021-05743-2
Abstract
The pharmacotherapy of Takayasu arteritis (TAK) with disease-modifying anti-rheumatic drugs (DMARDs) is an evolving area. A systematic review of Scopus, Web of Science, Pubmed Central, clinical trial databases and recent international rheumatology conferences for interventional and observational studies reporting the effectiveness of DMARDs in TAK identified four randomized controlled trials (RCTs, with another longer-term follow-up of one RCT) and 63 observational studies. The identified trials had some concern or high risk of bias. Most observational studies were downgraded on the Newcastle-Ottawa scale due to lack of appropriate comparator groups. Studies used heterogenous outcomes of clinical responses, angiographic stabilization, normalization of inflammatory markers, reduction in vascular uptake on positron emission tomography, reduction in prednisolone doses and relapses. Tocilizumab showed benefit in a RCT compared to placebo in a secondary per-protocol analysis but not the primary intention-to-treat analysis. Abatacept failed to demonstrate benefit compared to placebo for preventing relapses in another RCT. Pooled data from uncontrolled observational studies demonstrated beneficial clinical responses and angiographic stabilization in nearly 80% patients treated with tumour necrosis factor alpha inhibitors, tocilizumab or leflunomide. Certainty of evidence for outcomes from RCTs ranged from moderate to very low and was low to very low for all observational studies. There is a paucity of high-quality evidence to guide the pharmacotherapy of TAK. Future observational studies should attempt to include appropriate comparator arms. Multicentric, adequately powered RCTs assessing both clinical and angiographic responses are necessary in TAK.Funding Information
- Indian Council of Medical Research (5/4/1-2/2019-NCD-II)
This publication has 110 references indexed in Scilit:
- Short-term effect of leflunomide in patients with Takayasu arteritis: an observational studyScandinavian Journal of Rheumatology, 2012
- Tumor necrosis factor inhibitors in patients with Takayasu arteritis: Experience from a referral center with long‐term followupArthritis Care & Research, 2012
- EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteriaAnnals Of The Rheumatic Diseases, 2010
- Effect of Immunoglobulin Therapy on the Rate of Infections in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation and or treated with immunomodulatory agentsMediterranean Journal of Hematology and Infectious Diseases, 2010
- Anti-tumour necrosis factor therapy in patients with refractory Takayasu arteritis: long-term follow-upAnnals Of The Rheumatic Diseases, 2008
- Laboratory and febrile features after joint surgery in patients with rheumatoid arthritis treated with tocilizumabAnnals Of The Rheumatic Diseases, 2008
- Mycophenolate mofetil reduces disease activity and steroid dosage in Takayasu arteritisClinical Rheumatology, 2007
- Anti–tumor necrosis factor therapy in patients with difficult to treat Takayasu arteritisArthritis & Rheumatism, 2004
- Diagnostic criteria for Takayasu arteritisInternational Journal of Cardiology, 1996