Open AccessClinical interventions for Takayasu arteritis: A systematic review
Author(s) -
Pacheco Rafael L.,
Latorraca Carolina de Oliveira Cruz,
Souza Alexandre Wagner Silva,
Pachito Daniela V.,
Riera Rachel
Publication year - 2017
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.12993
Subject(s) - medicine , clinical trial , psychological intervention , adverse effect , sample size determination , systematic review , intensive care medicine , randomized controlled trial , medline , arteritis , critical appraisal , meta analysis , surgery , alternative medicine , pathology , statistics , mathematics , psychiatry , political science , law
Summary Introduction Takayasu arteritis ( TA ) is a rare systemic vasculitis that affects large vessels often resistant to treatment and associated with high morbidity and mortality. Treatment is defied by the relapsing nature of the disease and frequent adverse effects of corticosteroids and immunosuppressors, rendering failure of treatment in a significant portion of patients. Considering the low quantity and quality of published studies focusing on treatment of TA , synthesis and critical assessment of the available evidence is fundamental to establish recommendations for clinical practice. Objective To evaluate the effectiveness and safety of clinical interventions for TA . Methods Systematic review conducted in accordance to recommendations stated in the Cochrane Handbook, with inclusion of all comparative studies focusing on any type of clinical intervention for TA . Results Five comparative studies were included (one randomised clinical trial, two non‐randomised clinical trials, and two historical cohorts) totalling 342 patients, aiming at the assessment of effectiveness of corticosteroids, immunosuppressors, biologics and other types of pharmacological treatment for distinct clinical presentations of TA . The quality of studies, assessed by the use of instruments developed specifically for each study design, was considered low. Data scarcity and clinical heterogeneity prevented quantitative synthesis (meta‐analysis). Conclusion Despite an extensive literature search, few comparative studies with small sample sizes were retrieved. The quality of these studies was considered low, preventing recommendations on effectiveness and safety of the studied interventions for clinical practice. Until new comparative studies with more robust sample sizes are conducted, treatment of TA should be guided individually taking into account the severity of disease and the availability of treatment options.