Systematic Review and Meta-Analysis for JCS 2026 Guideline on Management of Large-Vessel Vasculitis.
Tsuyoshi Shirai, Tsuneyasu Yoshida, Eri Sugano et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis assessed randomized controlled trial evidence for treatments of Takayasu arteritis (TAK) and giant cell arteritis (GCA), to inform the 2026 Japanese Circulation Society guideline. Searches covered four databases through March 2024, and evidence certainty was mostly very low or low. In GCA, tocilizumab reduced relapse versus placebo at 52 weeks (RR 0.29, 95% CI 0.09-0.98) and increased remission (RR 3.56, 95% CI 2.29-5.54). Evidence for TAK was limited; serious adverse events were comparable between treatment groups.
Key findings
- In GCA, tocilizumab reduced relapse versus placebo at 52 weeks (RR 0.29, 95% CI 0.09-0.98).
- In GCA, tocilizumab increased remission versus placebo at 52 weeks (RR 3.56, 95% CI 2.29-5.54).
- For TAK, tocilizumab had a numerically lower relapse rate than placebo (RR 0.73, 95% CI 0.39-1.37); evidence was limited.
- Serious adverse events were comparable between treatment groups.
Why it matters
The review synthesizes randomized evidence across two forms of large-vessel vasculitis and identifies a treatment signal for tocilizumab in GCA. It also makes clear that certainty is generally low, particularly for TAK, and that findings may be affected by geographic variation and differences in trial entry criteria. These distinctions are important when interpreting evidence for guideline development.
What to keep in mind
Evidence certainty was very low for most critical outcomes, and evidence for TAK was limited. Geographic variation and differences in trial entry criteria were noted.