Giant Cell Arteritis: A Systematic Review and Meta-Analysis of Test Accuracy and Benefits and Harms of Common Treatments

Anisha B. Dua; Nedaa M. Husainat; Mohamad A. Kalot; Kevin Byram; Jason M. Springer; Karen E. James; Yih Chang Lin; Marat Turgunbaev; Alexandra Villa-Forte; Andy Abril; Carol Langford; Mehrdad Maz; Sharon A. Chung; Reem A. Mustafa

doi:10.1002/acr2.11226

Giant Cell Arteritis: A Systematic Review and Meta-Analysis of Test Accuracy and Benefits and Harms of Common Treatments

Anisha B. Dua, Nedaa M. Husainat, Mohamad A. Kalot, Kevin Byram, Jason M. Springer, Karen E. James, Yih Chang Lin, Marat Turgunbaev, Alexandra Villa-Forte, Andy Abril, Carol Langford, Mehrdad Maz, Sharon A. Chung, Reem A. Mustafa^*

^*Corresponding author for this work

Medicine, Rheumatology Division

Research output: Contribution to journal › Review article › peer-review

22 Scopus citations

Abstract

This systematic review compares treatment options for patients with giant cell arteritis (GCA) and evaluates the test accuracy of studies used in diagnosing and monitoring GCA. These studies were used to inform evidence-based recommendations for the American College of Rheumatology (ACR)/Vasculitis Foundation (VF) vasculitis management guidelines. A systematic review and search of articles in English in Ovid Medline, PubMed, Embase, and the Cochrane Library was conducted. Articles were screened for suitability, and studies presenting the highest level of evidence were given preference. Three hundred ninety-nine full-text articles addressing GCA questions were reviewed to inform 27 Population, Intervention, Comparison, and Outcome questions. No benefit was found with intravenous glucocorticoids (GCs) compared with high-dose oral GCs in patients with cranial ischemic symptoms (27.4% vs 12.3%; odds ratio [OR] 2.39 [95% confidence interval (CI) 0.75-7.62], [very low certainty of evidence]). Weekly tocilizumab with a 26-week GC taper was superior to a 52-week GC taper in patients achieving remission (risk ratio 4.00 [95% CI 1.97-8.12], [low certainty of evidence]). Non-GC immunosuppressive therapies with GCs compared with GCs alone showed no statistically significant in relapse at 1 year (OR 0.87 [95% CI 0.73-1.04], [moderate certainty of evidence]) or serious adverse events (OR 0.81 [95% CI 0.54-1.20]; [moderate certainty of evidence]). Temporal artery biopsy has a sensitivity of 61% (95% CI 38%-79%) and a specificity of 98% (95% CI 95%-99%) in patients with a clinical diagnosis of suspected GCA. This comprehensive systematic review synthesizes and evaluates the benefits and harms of different treatment options and the accuracy of commonly used tests for the diagnosis and monitoring of GCA.

Original language	English (US)
Pages (from-to)	429-441
Number of pages	13
Journal	ACR open rheumatology
Volume	3
Issue number	7
DOIs	https://doi.org/10.1002/acr2.11226
State	Published - Jul 2021

Funding

The systematic review team would like to acknowledge Amy Turner, Regina Parker, and Robin Lane for their assistance with administrative support, data management, and coordination of the project. The review team would also like to acknowledge the voting panel, expert panel, and patient panel members of the ACR vasculitis clinical practice guidelines 2020 for their review of the evidence and input during the guideline development process.

ASJC Scopus subject areas

Rheumatology

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10.1002/acr2.11226

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Dua, A. B., Husainat, N. M., Kalot, M. A., Byram, K., Springer, J. M., James, K. E., Chang Lin, Y., Turgunbaev, M., Villa-Forte, A., Abril, A., Langford, C., Maz, M., Chung, S. A., & Mustafa, R. A. (2021). Giant Cell Arteritis: A Systematic Review and Meta-Analysis of Test Accuracy and Benefits and Harms of Common Treatments. ACR open rheumatology, 3(7), 429-441. https://doi.org/10.1002/acr2.11226

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title = "Giant Cell Arteritis: A Systematic Review and Meta-Analysis of Test Accuracy and Benefits and Harms of Common Treatments",

abstract = "This systematic review compares treatment options for patients with giant cell arteritis (GCA) and evaluates the test accuracy of studies used in diagnosing and monitoring GCA. These studies were used to inform evidence-based recommendations for the American College of Rheumatology (ACR)/Vasculitis Foundation (VF) vasculitis management guidelines. A systematic review and search of articles in English in Ovid Medline, PubMed, Embase, and the Cochrane Library was conducted. Articles were screened for suitability, and studies presenting the highest level of evidence were given preference. Three hundred ninety-nine full-text articles addressing GCA questions were reviewed to inform 27 Population, Intervention, Comparison, and Outcome questions. No benefit was found with intravenous glucocorticoids (GCs) compared with high-dose oral GCs in patients with cranial ischemic symptoms (27.4% vs 12.3%; odds ratio [OR] 2.39 [95% confidence interval (CI) 0.75-7.62], [very low certainty of evidence]). Weekly tocilizumab with a 26-week GC taper was superior to a 52-week GC taper in patients achieving remission (risk ratio 4.00 [95% CI 1.97-8.12], [low certainty of evidence]). Non-GC immunosuppressive therapies with GCs compared with GCs alone showed no statistically significant in relapse at 1 year (OR 0.87 [95% CI 0.73-1.04], [moderate certainty of evidence]) or serious adverse events (OR 0.81 [95% CI 0.54-1.20]; [moderate certainty of evidence]). Temporal artery biopsy has a sensitivity of 61% (95% CI 38%-79%) and a specificity of 98% (95% CI 95%-99%) in patients with a clinical diagnosis of suspected GCA. This comprehensive systematic review synthesizes and evaluates the benefits and harms of different treatment options and the accuracy of commonly used tests for the diagnosis and monitoring of GCA.",

author = "Dua, {Anisha B.} and Husainat, {Nedaa M.} and Kalot, {Mohamad A.} and Kevin Byram and Springer, {Jason M.} and James, {Karen E.} and {Chang Lin}, Yih and Marat Turgunbaev and Alexandra Villa-Forte and Andy Abril and Carol Langford and Mehrdad Maz and Chung, {Sharon A.} and Mustafa, {Reem A.}",

note = "Publisher Copyright: {\textcopyright} 2021 The Authors. ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.",

year = "2021",

month = jul,

doi = "10.1002/acr2.11226",

language = "English (US)",

volume = "3",

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Dua, AB, Husainat, NM, Kalot, MA, Byram, K, Springer, JM, James, KE, Chang Lin, Y, Turgunbaev, M, Villa-Forte, A, Abril, A, Langford, C, Maz, M, Chung, SA & Mustafa, RA 2021, 'Giant Cell Arteritis: A Systematic Review and Meta-Analysis of Test Accuracy and Benefits and Harms of Common Treatments', ACR open rheumatology, vol. 3, no. 7, pp. 429-441. https://doi.org/10.1002/acr2.11226

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T2 - A Systematic Review and Meta-Analysis of Test Accuracy and Benefits and Harms of Common Treatments

AU - Dua, Anisha B.

AU - Husainat, Nedaa M.

AU - Kalot, Mohamad A.

AU - Byram, Kevin

AU - Springer, Jason M.

AU - James, Karen E.

AU - Chang Lin, Yih

AU - Turgunbaev, Marat

AU - Villa-Forte, Alexandra

AU - Abril, Andy

AU - Langford, Carol

AU - Maz, Mehrdad

AU - Chung, Sharon A.

AU - Mustafa, Reem A.

PY - 2021/7

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N2 - This systematic review compares treatment options for patients with giant cell arteritis (GCA) and evaluates the test accuracy of studies used in diagnosing and monitoring GCA. These studies were used to inform evidence-based recommendations for the American College of Rheumatology (ACR)/Vasculitis Foundation (VF) vasculitis management guidelines. A systematic review and search of articles in English in Ovid Medline, PubMed, Embase, and the Cochrane Library was conducted. Articles were screened for suitability, and studies presenting the highest level of evidence were given preference. Three hundred ninety-nine full-text articles addressing GCA questions were reviewed to inform 27 Population, Intervention, Comparison, and Outcome questions. No benefit was found with intravenous glucocorticoids (GCs) compared with high-dose oral GCs in patients with cranial ischemic symptoms (27.4% vs 12.3%; odds ratio [OR] 2.39 [95% confidence interval (CI) 0.75-7.62], [very low certainty of evidence]). Weekly tocilizumab with a 26-week GC taper was superior to a 52-week GC taper in patients achieving remission (risk ratio 4.00 [95% CI 1.97-8.12], [low certainty of evidence]). Non-GC immunosuppressive therapies with GCs compared with GCs alone showed no statistically significant in relapse at 1 year (OR 0.87 [95% CI 0.73-1.04], [moderate certainty of evidence]) or serious adverse events (OR 0.81 [95% CI 0.54-1.20]; [moderate certainty of evidence]). Temporal artery biopsy has a sensitivity of 61% (95% CI 38%-79%) and a specificity of 98% (95% CI 95%-99%) in patients with a clinical diagnosis of suspected GCA. This comprehensive systematic review synthesizes and evaluates the benefits and harms of different treatment options and the accuracy of commonly used tests for the diagnosis and monitoring of GCA.

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Giant Cell Arteritis: A Systematic Review and Meta-Analysis of Test Accuracy and Benefits and Harms of Common Treatments

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