Treatments for giant cell arteritis: Meta-analysis and assessment of estimates reliability using the fragility index

Seminars in Arthritis and Rheumatism
Alvise BertiM Hassan Murad

Abstract

To better communicate the results of randomized controlled trials (RCTs) of giant cell arteritis (GCA), we propose the use of the fragility index (FI), which is an intuitive measure defined as the minimum number of subjects whose status would have to change (e.g., from having the outcome to not) to render a statistically significant result nonsignificant, or vice-versa. We conducted a systematic review and random-effects meta-analysis of RCTs of glucocorticoid (GC) sparing strategies for relapse-free maintenance in GCA, and used the FI to simplify the presentation of results. Ten RCTs (nine phase II and one phase III enrolling 645 subjects) were included. Tocilizumab, IV GC and methotrexate significantly improved the likelihood of being relapse free with relative risks and 95% confidence intervals of 3.54 (2.28, 5.51), 5.11 (1.39, 18.81) and 1.54 (1.02, 2.30); respectively. The median FI was 4.5 (range, 1-28), and was generally higher for negative RCTs (n = 6; median FI 4.5) than for positive RCTs (n = 4; median FI 3.5). The range of FI per treatment was (1-8) for methotrexate, (2-6) for anti-TNF agents, 4 for abatacept, 3 for IV GC pulses and (4-28) for tocilizumab. Tocilizumab, IV GC and methotrexate improve the likelihood of...Continue Reading

Citations

Aug 8, 2018·Clinical Rheumatology·Alojzija HočevarMatija Tomšič
Dec 12, 2019·Circulation. Cardiovascular Quality and Outcomes·Muhammad Shahzeb KhanRichard A Krasuski
Apr 24, 2019·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Travis J MaticsJason M Kane
Dec 11, 2019·Rheumatology·Caroline Ming, John Stack
Apr 23, 2020·Journal of the American Academy of Dermatology·Sophia Z ShalhoutDavid M Miller
Feb 19, 2021·Seminars in Arthritis and Rheumatism·Philip TherkildsenEllen-Margrethe Hauge
Apr 11, 2021·BMC Cancer·Hao ZhangWenting Zeng
Aug 23, 2021·The Cochrane Database of Systematic Reviews·Aileen A AntonioSamuel A Abariga

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