Efficacy and Safety of Biological Agents in Giant Cell Arteritis: An Updated Meta-Analysis

TL;DR

This study finds that biological agents like tocilizumab help manage giant cell arteritis better than others, though they come with some risks.

Contribution

An updated meta-analysis comparing biological agents for giant cell arteritis, highlighting efficacy and safety differences.

Findings

Tocilizumab significantly increases remission rates in GCA patients compared to other treatments.

TNF inhibitors are associated with higher infection risks in GCA patients.

Biological agents show nonsignificant trends toward lower relapse rates and fewer adverse effects.

Abstract

Giant cell arteritis (GCA), impacting individuals over 50, causes vision loss, headaches, and jaw pain due to inflammation from proinflammatory cytokines and growth factors. Standard treatment involves glucocorticoids, with tocilizumab and tumor necrosis factor (TNF) inhibitors currently being studied.

This meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines, included adult GCA patients treated with biological agents. The search covered PubMed, Medline, Embase, and Scopus until October 2023, excluding nonhuman, pediatric, non-English, and nonrandomized studies. Data were analyzed using Review Manager 5.4, with random effects models calculating odds ratios (ORs) and 95% confidence intervals (CIs).

A meta-analysis of 11 studies (
n
 = 924) demonstrated higher remission rates with biological agents (OR = 2.58, 95% CI: 1.17–5.71;
p
 = 0.02;
I
2 
= 70%), especially tocilizumab (OR = 4.30, 95% CI: 1.22–15.21;
p
 = 0.02). Nonsignificant trends favored biological agents for relapse rates (OR = 0.52, 95% CI: 0.26–1.05;
p
 = 0.07) and control for adverse effects (OR = 0.70, 95% CI: 0.49–1.02;
p
 = 0.07). However, TNF inhibitors were linked to increased infection rates (OR = 2.41, 95% CI: 1.17–4.96;
p
 = 0.02).

Tocilizumab effectively induces remission in GCA patients, while abatacept and TNF inhibitors offer minimal benefits with increased infection risks, according to this meta-analysis. Treatment decisions should consider these factors, and larger studies are necessary to evaluate the safety and efficacy of biological agents in managing GCA.

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