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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
Aspirin as adjunctive treatment for giant cell arteritis
Susan P Mollan1, Noor Sharrack, Mike A Burdon
1Ophthalmology Department, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham, UK.
Insights
No studies currently support using low-dose aspirin alongside corticosteroids for giant cell arteritis (GCA). More research is needed to determine aspirin's safety and effectiveness in treating this serious condition.
Area of Science:
- Rheumatology
- Ophthalmology
- Vascular Medicine
Background:
- Giant cell arteritis (GCA) is a prevalent inflammatory condition affecting medium to large arteries, posing a risk of sudden blindness.
- Current standard treatment involves high-dose corticosteroids, which carry risks of side effects and may not prevent all ischemic complications.
- There is a need for alternative or adjunctive therapies to improve GCA management.
Purpose of the Study:
- To evaluate the safety and effectiveness of low-dose aspirin as an adjunctive treatment for giant cell arteritis (GCA).
Main Methods:
- A systematic literature search was conducted across multiple databases (CENTRAL, MEDLINE, EMBASE, LILACS, mRCT, ClinicalTrials.gov, WHO ICTRP, FDA) up to January 2014.
- Inclusion criteria focused on randomized controlled trials (RCTs) comparing GCA outcomes with and without adjunctive low-dose aspirin.
- Two independent reviewers assessed search results, but no trials met the inclusion criteria.
Main Results:
- No randomized controlled trials (RCTs) were identified that met the study's inclusion criteria.
- Consequently, no risk of bias assessment or meta-analysis was performed.
Conclusions:
- Currently, there is no RCT evidence to establish the safety or efficacy of low-dose aspirin as an adjunctive therapy for GCA.
- Clinicians should consider the known hemorrhagic risks of aspirin, particularly when used with corticosteroids.
- Effectiveness trials are essential to guide the management of GCA, a potentially blinding condition.
Background:
Giant cell arteritis (GCA) is a common inflammatory condition that affects medium and large-sized arteries and can cause sudden, permanent blindness. At present there is no alternative to early treatment with high-dose corticosteroids as the recommended standard management. Corticosteroid-induced side effects can develop and further disease-related ischaemic complications can still occur. Alternative and adjunctive therapies are sought. Aspirin has been shown to have effects on the immune-mediated inflammation in GCA, hence it may reduce damage caused in the arterial wall.
Objectives:
To assess the safety and effectiveness of low-dose aspirin, as an adjunctive, in the treatment of giant cell arteritis (GCA).
Search Methods:
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2013, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2014), EMBASE (January 1980 to January 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en) and the US Food and Drugs Administration (FDA) web site (www.fda.gov). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 24 January 2014.
Selection Criteria:
We planned to include only randomised controlled trials (RCTs) comparing outcomes of GCA with and without concurrent adjunctive use of low-dose aspirin.
Data Collection And Analysis:
Two authors independently assessed the search results for trials identified by the electronic searches. No trials met our inclusion criteria, therefore we undertook no assessment of risk of bias or meta-analysis.
Main Results:
We found no RCTs that met the inclusion criteria.
Authors' Conclusions:
There is currently no evidence from RCTs to determine the safety and efficacy of low-dose aspirin as an adjunctive treatment in GCA. Clinicians who are considering the use of low-dose aspirin as an adjunctive treatment in GCA must also recognise the established haemorraghic risks associated with aspirin, especially in the context of concurrent treatment with corticosteroids. There is a clear need for effectiveness trials to guide the management of this life-threatening condition.
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