The role of biological agents in the management of large vessel vasculitis (LVV): a systematic review and meta-analysis

• Published in: PloS one Vol. 9; no. 12; p. e115026
• Main Authors: Osman, Mohammed, Pagnoux, Christian, Dryden, Donna M, Storie, Dale, Yacyshyn, Elaine
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17.12.2014; Public Library of Science (PLoS)
• Subjects: Arteritis; Arthritis; Biological effects; Biological Factors - adverse effects; Biological Factors - therapeutic use; Biological treatment; Biology and Life Sciences; Biosafety; Care and treatment; Corticoids; Corticosteroid drugs; Corticosteroids; Cytokines; Disease; Drug dosages; Etanercept; Giant Cell Arteritis - drug therapy; Glucocorticoids; Humans; Infliximab; Medical imaging; Medicine and Health Sciences; Meta-analysis; Monoclonal antibodies; Patients; Pediatrics; Physical Sciences; Quality assessment; Reduction; Remission; Research and Analysis Methods; Rheumatic diseases; Rheumatism; Rheumatology; Studies; Systematic review; Takayasu Arteritis - drug therapy; Tumor necrosis factor-TNF; Tumor necrosis factor-α; Vasculitis; Vein & artery diseases
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0115026

Giant cell arteritis (GCA) and Takayasu's arteritis (TAA) are large vessel vasculitides (LVV) for which corticosteroids (CS) are the mainstay for treatment. In patients with LVV unable to tolerate CS, biological agents have been used with variable effectiveness. To systematically review the effectiveness and safety of biological agents in patients with LVV. We searched 5 electronic databases (inception to October 2012) and conference abstracts with no language restrictions. Two reviewers independently selected studies, extracted data and assessed methodological quality. Our protocol was registered in PROSPERO. We included 25 studies (3 RCTs and 22 case series with ≥2 cases). 95 GCA and 98 TAA patients received biological agents. The RCTs using anti-TNF agents (infliximab, etanercept and adalimumab) did not suggest a benefit in GCA. GCA patients receiving tocilizumab, in case series, achieved remission (19 patients) and reduction of corticosteroid dose (mean difference, -16.55 mg/day (95% CI: -26.24, -6.86)). In case series, 75 patients with refractory TAA treated with infliximab discontinued CS 32% of the time. Remission was variably defined and the studies were clinically heterogeneous which precluded further analysis. This systematic review demonstrated a weak evidence base on which to assess the effectiveness of biological treatment in LVV. Evidence from RCTs suggests that anti-TNF agents are not effective for remission or reduction of CS use. Tocilizumab and infliximab may be effective in the management of LVV and refractory TAA, respectively, although the evidence comes from case series. Future analytical studies are needed to confirm these findings.