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  • FRI0284 RESULTS OF A SYSTEMATIC LITERATURE REVIEW INFORMING THE 2018 UPDATE OF THE EULAR RECOMMENDATIONS FOR THE MANAGEMENT OF LARGE VESSEL VASCULITIS: EVIDENCE TO GUIDE THE MANAGEMENT OF GIANT CELL ARTERITIS

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Poster Presentations
Friday, 14 June 2019
Vasculitis
FRI0284 RESULTS OF A SYSTEMATIC LITERATURE REVIEW INFORMING THE 2018 UPDATE OF THE EULAR RECOMMENDATIONS FOR THE MANAGEMENT OF LARGE VESSEL VASCULITIS: EVIDENCE TO GUIDE THE MANAGEMENT OF GIANT CELL ARTERITIS
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  1. Sara Monti1,2,
  2. Ana Filipa Águeda3,
  3. Raashid Luqmani4,
  4. Frank Buttgereit5,
  5. Maria C. Cid6,
  6. Christian Dejaco7,
  7. Alfred Mahr8,
  8. Cristina Ponte9,
  9. Carlo Salvarani10,
  10. Wolfgang A. Schmidt11,
  11. Bernhard Hellmich12
  1. 1IRCCS Policlinico S. Matteo Foundation, University of Pavia, Department of Rheumatology, Pavia, Italy
  2. 2University of Pavia, PhD in Experimental Medicine, Pavia, Italy
  3. 3Centro Hospitalar do Baixo Vouga E.P.E., Department of Rheumatology, Aveiro, Portugal
  4. 4University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom
  5. 5Charité University Medicine Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany
  6. 6University of Barcelona. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Vasculitis Research Unit, Hospital Clinic, Barcelona, Spain
  7. 7South Tyrol Health Trust, Hospital of Bruneck, Department of Rheumatology, Bruneck, Italy
  8. 8Hopital Saint Louis, Paris, France
  9. 9Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Department of Rheumatology, Lisbon, Portugal
  10. 10Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Department of Rheumatology, Reggio Emilia, Italy
  11. 11Immanuel Krankenhaus, Klinik für Innere Medizin, Rheumatologie und Klinische Immunologie Berlin-Buch, Berlin, Germany
  12. 12Akademisches Lehrkrankenhaus der Universität Tübingen, Klinik für Innere Medizin, Rheumatologie und Immunologie, Vaskulitis-Zentrum Süd, Medius Kliniken, Kirchheim-unter-Teck, Germany

Abstract

Background: The latest EULAR recommendations for the management of large vessel vasculitis (LVV) were published in 2009 (1). Since then, imaging has become a reliable diagnostic tool and new therapeutic options are available for giant cell arteritis (GCA), supporting the need to update the recommendations.

Objectives: To analyse the current evidence for the management (diagnosis/monitoring and treatment) of LVV to inform the 2018 update of the EULAR recommendations.

Methods: A systematic literature review (SLR) dealing with diagnosis/monitoring and treatment strategies for LVV, respectively, was performed. Medline, Embase and Cochrane databases were searched from inception until 31st December 2017. Evidence on imaging was excluded in light of recently published EULAR recommendations (2). We reviewed data relevant to GCA. Level of Evidence (LoE), was assessed in accordance with the 2009 Oxford Centre for Evidence-based Medicine.

Results: We identified 283 papers from the SLR. The implementation of a fast-track approach to diagnosis significantly lowered the risk of permanent visual loss compared to historical cohorts (Level of evidence – LoE 2b). The SLR confirmed the efficacy of prompt initiation of glucocorticoids (GC). There was no high-quality evidence on the most appropriate starting dose, route of administration, tapering and duration of GC (LoE 4). Patients with GCA are at increased risk of dose-dependent GC-related adverse events (LoE 3b). The addition of methotrexate (MTX) (LoE 1a) or tocilizumab (TCZ) reduced relapse rates and GC requirements (LoE 1b). There was no consistent evidence that anti-platelet agents given at the time of GCA diagnosis prevented future ischaemic events (LoE 2a). There was little evidence to guide monitoring of patients with GCA.

Conclusion: Results from a SLR confirmed the importance of a prompt diagnosis and rapid initiation of GC therapy. Patients with GCA are at an increased risk for GC-related comorbidities. MTX and TCZ can reduce GC exposure and relapse rates. There are yet no high-quality data to guide monitoring and duration of treatment in GCA.

References: [1] Mukhtyar C, et al. EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis2009;68:318-23.

[2] Dejaco C, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis. 2018;77:636-43.

Disclosure of Interests: Sara Monti: None declared, Ana Filipa Águeda: None declared, Raashid Luqmani Grant/research support from: Roche, Vifor and GSK, Frank Buttgereit: None declared, Maria C. Cid Grant/research support from: Kiniksa Pharmaceuticals, Consultant for: Roche, GSK, Janssen, Abbvie, Speakers bureau: Boehringer-Inhelheim, Vifor, Christian Dejaco Speakers bureau: MSD, Pfizer, UCB, AbbVie, Roche, Novartis, Lilly, Celgene, Merck, Sandoz, Alfred Mahr Consultant for: Chugai Pharma France, Speakers bureau: Roche SAS Chugai Pharma France, Cristina Ponte Speakers bureau: Roche, Carlo Salvarani Grant/research support from: Roche, Consultant for: Eli Lilly and Company, Roche, Abbvie, Wolfgang A. Schmidt: None declared, Bernhard Hellmich Consultant for: Roche, Speakers bureau: Abbvie, MSD, Roche, Novartis, Pfizer

https://doi.org/10.1136/annrheumdis-2019-eular.5873

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