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Efficacy and safety of tocilizumab in treatment of Takayasu arteritis: a systematic review of randomized controlled trials

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Singh, A, Danda, D, Hussain, S, Najmi, AK, Mathew, A, Goel, R, Lakhan, SE, Tajudheen, B and Antony, B ORCID: 0000-0001-8704-6084 2020 , 'Efficacy and safety of tocilizumab in treatment of Takayasu arteritis: a systematic review of randomized controlled trials' , Modern Rheumatology , pp. 1-8 , doi: 10.1080/14397595.2020.1724671.

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Abstract

Background: Takayasu arteritis (TAK) is a chronic immune vasculitis in which Interleukin-6 (IL-6) receptors play a key role in pathogenesis. Tocilizumab (TCZ), an IL-6 receptor antagonist with a favorable safety and efficacy profile, has been tried as an option for patients with TAK. This systematic review analyzed the evidence from randomized control trials (RCT) assessing the safety and efficacy of TCZ in patients with TAK.Methods: MEDLINE, Embase, the Cochrane Library, and clinical trial registries were searched from inception to July 2018. We included RCT assessing the efficacy and safety of TCZ versus placebo/other comparators for the treatment of patients with TAK. The risk of bias (RoB) was assessed using Cochrane RoB tool.Results: 2799 identified articles were screened as per abstract and title; 42 selected full-texts articles were assessed for the potential inclusion. One trial, reported in two publications, comparing subcutaneous TCZ (162 mg/week) versus matching placebo in 36 patients with TAK was included. The relapse-free rate at 24 weeks was 50.6% and 22.9% in TCZ and placebo arm, respectively. The hazard ratio (HR) for time to first relapse was statistically significant in the per-protocol population (HR 0.34 [95.41% CI, 0.11-1.00]; p = .0345), while non-significant in the intention-to-treat population (HR 0.41 [95.41% CI, 0.15-1.10]; p = .0596). The serious adverse events were higher in the placebo arm.Conclusions: This systematic review finds the existing evidence from RCT on efficacy and safety profile of TCZ in TAK to be promising but limited. Additional evidence is required to draw a stronger conclusion.

Item Type: Article
Authors/Creators:Singh, A and Danda, D and Hussain, S and Najmi, AK and Mathew, A and Goel, R and Lakhan, SE and Tajudheen, B and Antony, B
Keywords: Takayasu arteritis, large vessel vasculitis, systematic review, tocilizumab, meta-analysis
Journal or Publication Title: Modern Rheumatology
Publisher: Taylor & Francis
ISSN: 1439-7595
DOI / ID Number: 10.1080/14397595.2020.1724671
Copyright Information:

Copyright 2020 Japan College of Rheumatology. This is a post-peer-review, pre-copyedit version of an article published in Modern Rheumatology. The final authenticated version is available online at: http://dx.doi.org/10.1080/14397595.2020.1724671

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