Prednisolone combined with adjunctive immunosuppression is not superior to prednisolone alone in terms of efficacy and safety in giant cell arteritis: meta-analysis
- 12 September 2013
- journal article
- research article
- Published by Springer Science and Business Media LLC in Clinical Rheumatology
- Vol. 33 (2), 227-236
- https://doi.org/10.1007/s10067-013-2384-2
Abstract
To conduct a meta-analysis of published data of the effectiveness of drug treatment in giant cell arteritis (GCA) to provide evidence to support the optimal use of glucocorticoids (GCs) and adjunct therapy. MEDLINE, CENTRAL and EMBASE searches were used to identify randomised control trials on the treatment of GCA. Studies included were trials in which: (1) the participants were classified as having GCA by the 1990 ACR criteria or biopsy proven disease; (2) parallel-group randomised control of at least 16 weeks duration had been conducted with at least 20 participants; (3) the design included either alternative adjunct immunosuppressant regimens, alternative GCs dosing or routes of administration; and (4) outcome data was included on either relapse rates or rates of infection. One thousand eight hundred thirty-six articles were retrieved, of which only 37 met the primary inclusion criteria. Sixteen of these studies reported some information about the GCs or adjuvant regimen used. Only ten studies were of sufficient quality to be included in the meta-analysis. Together these comprised 638 participants of which 72 % were female. Three studies compared various GCs regimens, with two comparing IV GCs, the latter showing a marginal benefit with respect to relapse (risk ratio (RR) = 0.78, 95 % CI = 0.54 to 1.12) but a greater risk of infection (RR = 1.58, 95 % CI = 0.90 to 2.78). Another three used methotrexate as an adjunctive agent and showed marginal benefit with respect to relapse (RR = 0.85, 95 % CI = 0.66 to 1.11). The remaining four trials compared prednisolone to dapsone, infliximab, adalimumab and hydroxychloroquine, respectively. There are various clinical trials of varying quality. The results from this meta-analysis show that the use of adjunct agents is not associated with improved outcomeThis publication has 33 references indexed in Scilit:
- Increased IL-17A expression in temporal artery lesions is a predictor of sustained response to glucocorticoid treatment in patients with giant-cell arteritisAnnals Of The Rheumatic Diseases, 2012
- Development of Outcome Measures for Large-vessel Vasculitis for Use in Clinical Trials: Opportunities, Challenges, and Research AgendaThe Journal of Rheumatology, 2011
- Successful use of tocilizumab in polymyalgic onset biopsy positive GCA with large vessel involvementBMJ Case Reports, 2011
- Th17 and Th1 T-Cell Responses in Giant Cell ArteritisCirculation, 2010
- Risk factors for early visual deterioration in temporal arteritisJournal of Neurology, Neurosurgery & Psychiatry, 2007
- A double-blind placebo controlled trial of etanercept in patients with giant cell arteritis and corticosteroid side effectsAnnals Of The Rheumatic Diseases, 2007
- Adjunctive methotrexate for treatment of giant cell arteritis: An individual patient data meta‐analysisArthritis & Rheumatism, 2007
- Incidence of diagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom, 1990-2001Annals Of The Rheumatic Diseases, 2006
- Glucocorticoid therapy in giant cell arteritis: Duration and adverse outcomesArthritis Care & Research, 2003
- La Dapsone dans le traitement de la maladie de Horton. Efficacité et toléranceLa Revue de Médecine Interne, 1990