Indirect Comparison of Glucocorticoid-Sparing Agents for Remission Maintenance in Giant Cell Arteritis: A Network Meta-analysis |
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| Institution: | 1. Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France;2. Lyon immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon, France;3. Service de pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France;4. Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France;5. Service de médecine interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France;6. Service de court séjour gériatrique, Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France;7. Université de Lyon, Université Lyon 1, Health Services and Performance Research EA7425, Lyon, France;8. Service de médecine interne et d’immunologie clinique, CHU Dijon Bourgogne, Hôpital François Mitterrand, Dijon, France;1. Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA;2. VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA;3. Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL;4. John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA;1. Department of Neurologic Surgery, Mayo Clinic, Rochester MN;2. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester MN;3. Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester MN;4. Department of Radiation Oncology, Mayo Clinic, Rochester MN;5. Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN;1. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia;2. Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia;3. Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA;4. Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA;5. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;6. Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland;7. Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland;8. Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA |
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| Abstract: | ObjectiveTo compare and rank the effect of glucocorticoid-sparing agents in giant cell arteritis (GCA), for which several drugs have been evaluated but with a benefit-risk balance that remains uncertain.MethodsThe MEDLINE and Clinical Trials databases were searched up to November 2021; all randomized controlled trials investigating glucocorticoids in GCA were included. The glucocorticoid regimen was dichotomized into short (≤6 months) or prolonged (>6 months) use. Risk of relapse and safety were estimated using network meta-analysis with frequentist random effects models.ResultsOf the 96 records screened, 8 trials were included (572 patients). The trials compared glucocorticoids and a sparing agent: tocilizumab (2 trials), oral methotrexate (3 trials), infliximab (1 trial), etanercept (1 trial), and adalimumab (1 trial). The pooled prevalence of GCA relapse was 52.6% (95% CI, 38.1 to 66.9). The risk of relapse was significantly lower with tocilizumab compared with methotrexate (relative risk RR], 0.41; 95% CI, 0.17 to 0.97) and prolonged (RR, 0.41; 95% CI, 0.20 to 0.83) and short (RR, 0.32; 95% CI, 0.16 to 0.66) glucocorticoid use. The risk of relapse was not significantly different with methotrexate compared with short (RR, 0.79; 95% CI, 0.48 to 1.31) and prolonged (RR, 0.95; 95% CI, 0.31 to 2.89) glucocorticoid use. The frequency of serious adverse events and serious infection was comparable between the different drugs. The certainty of the evidence was low to very low.ConclusionThis meta-analysis suggests that tocilizumab may be superior to other sparing agents to prevent GCA relapse, but with a low to very low certainty of evidence, and that safety is comparable to the other drugs.RegistrationThe protocol of the meta-analysis is registered in the international prospective register of systematic reviews PROSPERO (https://www.crd.york.ac.uk/prospero/; registration CRD42020112387). |
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| Keywords: | GCA"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"giant cell arteritis RCT"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"randomized controlled trial RR"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"relative risk SAE"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"serious adverse event |
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