Systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

Focus on giant cell arteritis

Sara Monti, Ana F. Águeda, Raashid Ahmed Luqmani, Frank Buttgereit, Maria Cid, Christian Dejaco, Alfred Mahr, Cristina Ponte, Carlo Salvarani, Wolfgang Schmidt, Bernhard Hellmich

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: To analyse the current evidence for the management of large vessel vasculitis (LVV) to inform the 2018 update of the EULAR recommendations. Methods: Two systematic literature reviews (SLRs) dealing with diagnosis/monitoring and treatment strategies for LVV, respectively, were performed. Medline, Embase and Cochrane databases were searched from inception to 31 December 2017. Evidence on imaging was excluded as recently published in dedicated EULAR recommendations. This paper focuses on the data relevant to giant cell arteritis (GCA). Results: We identified 287 eligible articles (122 studies focused on diagnosis/monitoring, 165 on treatment). The implementation of a fast-track approach to diagnosis significantly lowers the risk of permanent visual loss compared with historical cohorts (level of evidence, LoE 2b). Reliable diagnostic or prognostic biomarkers for GCA are still not available (LoE 3b). The SLR confirms the efficacy of prompt initiation of glucocorticoids (GC). There is no high-quality evidence on the most appropriate starting dose, route of administration, tapering and duration of GC (LoE 4). Patients with GCA are at increased risk of dose-dependent GC-related adverse events (LoE 3b). The addition of methotrexate or tocilizumab reduces relapse rates and GC requirements (LoE 1b). There is no consistent evidence that initiating antiplatelet agents at diagnosis would prevent future ischaemic events (LoE 2a). There is little evidence to guide monitoring of patients with GCA. Conclusions: Results from two SLRs identified novel evidence on the management of GCA to guide the 2018 update of the EULAR recommendations on the management of LVV.

Original languageEnglish
Article numbere001003
JournalRMD Open
Volume5
Issue number2
DOIs
Publication statusPublished - Sep 1 2019

Fingerprint

Giant Cell Arteritis
Vasculitis
Glucocorticoids
Platelet Aggregation Inhibitors
Physiologic Monitoring
Methotrexate
Biomarkers
Databases
Recurrence
Therapeutics

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

Systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis : Focus on giant cell arteritis. / Monti, Sara; Águeda, Ana F.; Luqmani, Raashid Ahmed; Buttgereit, Frank; Cid, Maria; Dejaco, Christian; Mahr, Alfred; Ponte, Cristina; Salvarani, Carlo; Schmidt, Wolfgang; Hellmich, Bernhard.

In: RMD Open, Vol. 5, No. 2, e001003, 01.09.2019.

Research output: Contribution to journalArticle

Monti, Sara ; Águeda, Ana F. ; Luqmani, Raashid Ahmed ; Buttgereit, Frank ; Cid, Maria ; Dejaco, Christian ; Mahr, Alfred ; Ponte, Cristina ; Salvarani, Carlo ; Schmidt, Wolfgang ; Hellmich, Bernhard. / Systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis : Focus on giant cell arteritis. In: RMD Open. 2019 ; Vol. 5, No. 2.
@article{1ce771b84bab4b5294e29b8ae1e7b871,
title = "Systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis: Focus on giant cell arteritis",
abstract = "Objectives: To analyse the current evidence for the management of large vessel vasculitis (LVV) to inform the 2018 update of the EULAR recommendations. Methods: Two systematic literature reviews (SLRs) dealing with diagnosis/monitoring and treatment strategies for LVV, respectively, were performed. Medline, Embase and Cochrane databases were searched from inception to 31 December 2017. Evidence on imaging was excluded as recently published in dedicated EULAR recommendations. This paper focuses on the data relevant to giant cell arteritis (GCA). Results: We identified 287 eligible articles (122 studies focused on diagnosis/monitoring, 165 on treatment). The implementation of a fast-track approach to diagnosis significantly lowers the risk of permanent visual loss compared with historical cohorts (level of evidence, LoE 2b). Reliable diagnostic or prognostic biomarkers for GCA are still not available (LoE 3b). The SLR confirms the efficacy of prompt initiation of glucocorticoids (GC). There is no high-quality evidence on the most appropriate starting dose, route of administration, tapering and duration of GC (LoE 4). Patients with GCA are at increased risk of dose-dependent GC-related adverse events (LoE 3b). The addition of methotrexate or tocilizumab reduces relapse rates and GC requirements (LoE 1b). There is no consistent evidence that initiating antiplatelet agents at diagnosis would prevent future ischaemic events (LoE 2a). There is little evidence to guide monitoring of patients with GCA. Conclusions: Results from two SLRs identified novel evidence on the management of GCA to guide the 2018 update of the EULAR recommendations on the management of LVV.",
author = "Sara Monti and {\'A}gueda, {Ana F.} and Luqmani, {Raashid Ahmed} and Frank Buttgereit and Maria Cid and Christian Dejaco and Alfred Mahr and Cristina Ponte and Carlo Salvarani and Wolfgang Schmidt and Bernhard Hellmich",
year = "2019",
month = "9",
day = "1",
doi = "10.1136/rmdopen-2019-001003",
language = "English",
volume = "5",
journal = "RMD Open",
issn = "2056-5933",
publisher = "BMJ Publishing Group",
number = "2",

}

TY - JOUR

T1 - Systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

T2 - Focus on giant cell arteritis

AU - Monti, Sara

AU - Águeda, Ana F.

AU - Luqmani, Raashid Ahmed

AU - Buttgereit, Frank

AU - Cid, Maria

AU - Dejaco, Christian

AU - Mahr, Alfred

AU - Ponte, Cristina

AU - Salvarani, Carlo

AU - Schmidt, Wolfgang

AU - Hellmich, Bernhard

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Objectives: To analyse the current evidence for the management of large vessel vasculitis (LVV) to inform the 2018 update of the EULAR recommendations. Methods: Two systematic literature reviews (SLRs) dealing with diagnosis/monitoring and treatment strategies for LVV, respectively, were performed. Medline, Embase and Cochrane databases were searched from inception to 31 December 2017. Evidence on imaging was excluded as recently published in dedicated EULAR recommendations. This paper focuses on the data relevant to giant cell arteritis (GCA). Results: We identified 287 eligible articles (122 studies focused on diagnosis/monitoring, 165 on treatment). The implementation of a fast-track approach to diagnosis significantly lowers the risk of permanent visual loss compared with historical cohorts (level of evidence, LoE 2b). Reliable diagnostic or prognostic biomarkers for GCA are still not available (LoE 3b). The SLR confirms the efficacy of prompt initiation of glucocorticoids (GC). There is no high-quality evidence on the most appropriate starting dose, route of administration, tapering and duration of GC (LoE 4). Patients with GCA are at increased risk of dose-dependent GC-related adverse events (LoE 3b). The addition of methotrexate or tocilizumab reduces relapse rates and GC requirements (LoE 1b). There is no consistent evidence that initiating antiplatelet agents at diagnosis would prevent future ischaemic events (LoE 2a). There is little evidence to guide monitoring of patients with GCA. Conclusions: Results from two SLRs identified novel evidence on the management of GCA to guide the 2018 update of the EULAR recommendations on the management of LVV.

AB - Objectives: To analyse the current evidence for the management of large vessel vasculitis (LVV) to inform the 2018 update of the EULAR recommendations. Methods: Two systematic literature reviews (SLRs) dealing with diagnosis/monitoring and treatment strategies for LVV, respectively, were performed. Medline, Embase and Cochrane databases were searched from inception to 31 December 2017. Evidence on imaging was excluded as recently published in dedicated EULAR recommendations. This paper focuses on the data relevant to giant cell arteritis (GCA). Results: We identified 287 eligible articles (122 studies focused on diagnosis/monitoring, 165 on treatment). The implementation of a fast-track approach to diagnosis significantly lowers the risk of permanent visual loss compared with historical cohorts (level of evidence, LoE 2b). Reliable diagnostic or prognostic biomarkers for GCA are still not available (LoE 3b). The SLR confirms the efficacy of prompt initiation of glucocorticoids (GC). There is no high-quality evidence on the most appropriate starting dose, route of administration, tapering and duration of GC (LoE 4). Patients with GCA are at increased risk of dose-dependent GC-related adverse events (LoE 3b). The addition of methotrexate or tocilizumab reduces relapse rates and GC requirements (LoE 1b). There is no consistent evidence that initiating antiplatelet agents at diagnosis would prevent future ischaemic events (LoE 2a). There is little evidence to guide monitoring of patients with GCA. Conclusions: Results from two SLRs identified novel evidence on the management of GCA to guide the 2018 update of the EULAR recommendations on the management of LVV.

UR - http://www.scopus.com/inward/record.url?scp=85068591312&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068591312&partnerID=8YFLogxK

U2 - 10.1136/rmdopen-2019-001003

DO - 10.1136/rmdopen-2019-001003

M3 - Article

VL - 5

JO - RMD Open

JF - RMD Open

SN - 2056-5933

IS - 2

M1 - e001003

ER -