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Prednisolone combined with adjunctive immunosuppression is not superior to prednisolone alone in terms of efficacy and safety in giant cell arteritis: meta-analysis

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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 outcome.

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Key messages

The available data from the clinical trials are of varying quality.

In remission induction, the data from the clinical trials show no additional benefit for combination therapy. Development of validated outcomes in GCA is urgently required.

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Authors and Affiliations

  1. Department of Rheumatology, Norfolk and Norwich University Hospital, Colney Lane, NR4 7UY, UK

    M. Yates & A. J. MacGregor

  2. University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK

    M. Yates & A. J. MacGregor

  3. Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK

    Y. K. Loke, R. A. Watts & A. J. MacGregor

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  1. M. Yates
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Correspondence to M. Yates.

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Yates, M., Loke, Y.K., Watts, R.A. et al. Prednisolone combined with adjunctive immunosuppression is not superior to prednisolone alone in terms of efficacy and safety in giant cell arteritis: meta-analysis. Clin Rheumatol 33, 227–236 (2014). https://doi.org/10.1007/s10067-013-2384-2

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