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Biological therapy for systemic vasculitis: a systematic review.
Lucía Silva-Fernández1, Estíbaliz Loza2, Víctor M Martínez-Taboada3
1Rheumatology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain.
Seminars in Arthritis and Rheumatism
|August 28, 2013
Summary
Biological agents offer new hope for systemic vasculitis (SV) patients, with rituximab showing promise for remission induction in ANCA-associated vasculitis (AAV). Evidence is primarily observational, highlighting the need for further research.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Systemic vasculitis (SV) frequently involves relapses and treatment failures.
- Biological agents are increasingly used as rescue therapies for SV.
- Evidence on their efficacy and safety requires systematic evaluation.
Purpose of the Study:
- To conduct a systematic review of current evidence on the therapeutic use of biological agents in systemic vasculitis (SV).
Main Methods:
- Searched MEDLINE, EMBASE, Cochrane reviews, and CENTRAL up to April 2013.
- Included systematic reviews, meta-analyses, clinical trials, cohort studies, and case series (>3 patients).
- Two independent investigators assessed article quality and resolved discrepancies.
Main Results:
- 90 studies were included from 3447 screened citations.
- Rituximab demonstrated efficacy for remission induction in ANCA-associated vasculitis (AAV).
- Anti-TNF agents showed variable results; abatacept, alemtuzumab, mepolizumab, and tocilizumab had limited supporting data.
Conclusions:
- Current evidence for biological therapies in SV is largely from uncontrolled, observational data.
- Rituximab is comparable to cyclophosphamide for AAV remission induction and potentially superior in relapsing cases.
- Infliximab, adalimumab, and tocilizumab show promise as steroid-sparing or remission-inducing agents in AAV and large vessel vasculitis (LVV).
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