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01-10-2021 | Angiography | Systematic Review

Corticosteroid monotherapy for the management of Takayasu arteritis—a systematic review and meta-analysis

Authors: Durga Prasanna Misra, Upendra Rathore, Pallavi Patro, Vikas Agarwal, Aman Sharma

Published in: Rheumatology International | Issue 10/2021

Abstract

We evaluated clinical response, normalization of inflammatory markers, angiographic stabilization (primary outcomes), relapses and adverse events (secondary outcomes) in Takayasu arteritis (TAK) patients following corticosteroid monotherapy. MEDLINE, EMBASE, Web of Science, Scopus, Pubmed Central, Cochrane library, clinical trial databases and major international Rheumatology conferences were searched for studies reporting outcomes in TAK following corticosteroid monotherapy (without language/date restrictions). Risk ratios were calculated for controlled studies. Proportions were pooled for uncontrolled studies. Heterogeneity was assessed using I² statistic. Quality assessment of individual studies utilized the Newcastle–Ottawa scale. GRADE methodology ascertained certainty of individual outcomes across studies. Twenty-eight observational studies (1098 TAK) were identified. Twenty-three uncontrolled studies (580 TAK) were synthesized in meta-analysis. Clinical response was observed in 60% (95% CI 45–74%, 19 studies), normalization of inflammatory markers in 84% (95% CI 54–100%, 4 studies) and angiographic stabilization in 28% (95% CI 6–57%, 4 studies). Relapses occurred in 66% (95% CI 18–99%, 4 studies). Adverse events were reported in 51% (95% CI 2–99%, 4 studies). All pooled estimates had considerable heterogeneity, unexplained by subgroup analyses (time period, geographic location or number of patients). Two studies reported lesser restenosis following vascular surgery and fewer relapses when corticosteroids were combined with immunosuppressants compared with corticosteroid monotherapy. All outcomes had very low certainty. While corticosteroid monotherapy induces clinical response in most TAK patients, angiographic stabilization is observed in fewer than one-third. Most patients relapse following corticosteroid withdrawal. Preliminary evidence supports up-front addition of immunosuppressants to retard angiographic progression and reduce relapses (PROSPERO identifier CRD42021242910).

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Title: Corticosteroid monotherapy for the management of Takayasu arteritis—a systematic review and meta-analysis
Authors: Durga Prasanna Misra
Upendra Rathore
Pallavi Patro
Vikas Agarwal
Aman Sharma
Publication date: 01-10-2021
Publisher: Springer Berlin Heidelberg
Keywords: Angiography
Takayasu's Arteriitis
Takayasu's Arteriitis
Disease Modifying Anti-Rheumatic Drug
Published in: Rheumatology International / Issue 10/2021
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI: https://doi.org/10.1007/s00296-021-04958-5

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