Systematic Review and Meta-Analysis for JCS 2026 Guideline on Management of Large-Vessel Vasculitis

Area of Science:

• Rheumatology
• Immunology
• Internal Medicine

Background:

• Large-vessel vasculitis (LVV) encompasses Takayasu arteritis (TAK) and giant cell arteritis (GCA).
• Evidence from randomized controlled trials (RCTs) is crucial for updating clinical practice guidelines.
• The 2026 Japanese Circulation Society (JCS) guideline requires robust evidence synthesis.

Purpose of the Study:

• To systematically review RCTs for LVV therapies.
• To provide evidence for the 2026 JCS clinical practice guideline on LVV.
• To inform treatment decisions for Takayasu arteritis and giant cell arteritis.

Main Methods:

• Conducted a systematic review of RCTs using major databases (PubMed, CENTRAL, EMBASE, JMAS) through March 2024.
• Drafted clinical questions for TAK and GCA.
• Assessed the certainty of evidence using the GRADE approach.

Main Results:

• Evidence for Takayasu arteritis (TAK) was limited.
• Tocilizumab (TCZ) showed a numerical benefit in relapse rate for TAK versus placebo and was similar to adalimumab.
• In giant cell arteritis (GCA), TCZ significantly reduced relapse and increased remission rates compared to placebo at 52 weeks; other agents showed no benefit in cranial GCA.

Conclusions:

• This systematic review provides a comprehensive synthesis of RCT evidence for LVV therapies.
• The findings support the development of the 2026 JCS clinical practice guideline.
• The certainty of evidence for most outcomes was low to very low, highlighting the need for further research.