Biologic therapies for the treatment of large vessel vasculitis: A systematic review and meta-analysis

Objective: To summarize the existing evidence from double-blind randomized controlled trials (RCTs) and cohort studies regarding the effects of biologic agents for the treatment of large vessel vasculitis (LVV). Methods: A systematic review and meta-analysis was conducted using MEDLINE, Embase, Cochrane Central Registry of Controlled Trials, and ClinicalTrials.gov covering the period from database inception to May 3rd, 2023. Double-blind RCTs and cohort studies reporting biologic therapies’ effects on LVV including giant cell arteritis (GCA) and Takayasu’s arteritis (TAK) with outcomes of interest in English were included. The primary outcome of interest was relapse rates during glucocorticoid tapering. The Cochrane Risk of Bias tool 2.0 and the Risk of Bias In Non-randomized Studies of Interventions tool were used for the quality assessment. Random-effects models were used for meta-analysis. Results: Of the 4599 references retrieved, 10 RCTs regarding GCA, 6 cohort studies, and 2 RCTs regarding TAK were included, comprising 997 participants in total. All the included RCTs were of low risk of bias, while the 6 cohort studies were of moderate to serious risk of bias. Meta-analysis suggested a significant superiority of biologic agents in prolonging relapse-free survival, increasing glucocorticoid taper rate, and decreasing cumulative glucocorticoids dose for both GCA and TAK. Additionally, GCA patients using biologic agents had significantly lower relapse rates and ESR levels with higher remission rates. Trends of favoring biologic agents in reducing relapse rate, ITAS-2010, ITAS-A, ESR, and CRP along with increased remission rate for TAK were also observed. Conclusions: Biologic agents significantly improved clinical outcomes in LVV by reducing relapse rates, enhancing remission, and enabling safer glucocorticoid tapering, offering an important therapeutic advantage for managing both GCA and TAK. Further well-designed studies and corresponding meta-analyses are needed to validate their long-term efficacy and safety.