Comparative Effectiveness and Safety of Biologic Treatments in Giant Cell Arteritis: A Network Meta-analysis of Randomized Controlled Trials

Background: The relative efficacy and safety of the biological therapies were compared by a network meta-analysis for giant cell arteritis (GCA). Methods: We searched MEDLINE, EMBASE, and Cochrane databases to identify randomized controlled trials (RCTs) that assessed the efficacy and safety of tocilizumab, mavrilimumab, abatacept, and tumor necrosis factor (TNF) inhibitors for GCA treatment. The RoB 2.0 version of the Cochrane risk-of-bias instrument was used to assess the quality of the RCTs and a risk-ofbias and grading of recommendations assessment, development and evaluation (GRADE) were performed to ascertain the certainty of the evidence. The direct and indirect RCT findings were combined using a Bayesian network meta-analysis. Results: A total of eight RCTs involving 533 patients were included. One RCTs had a high risk of bias, four had some concerns, and three had a low risk of bias. Except for one comparison, the overall certainty of the treatment effects was rated as moderate. Compared to TNF inhibitor and placebo, tocilizumab showed a greater rate of remission (odds ratio [OR], 5.68, 95% credible interval [CrI], 2.21-14.79; OR, 7.40, 95% Cr, 4.09-13.94). Tocilizumab had the best chance of being the best therapy based on the remission rate, followed by mavrilimumab, abatacept, TNF inhibitor, and placebo, according to the surface under the cumulative ranking curve (SUCRA)-based likelihood rating analysis. Tocilizumab demonstrated the highest probability of being a more effective relapse-based treatment than the other drugs, which were classified in decreasing order as follows: mavrilimumab, abatacept, TNF inhibitor, and placebo. The placebo was more likely to be the safest course of action, followed by mavrilimumab, abatacept, tocilizumab, and a TNF inhibitor. Conclusion: Tocilizumab may be the most efficient remission-inducing and relapse-lowering biological agent for patients with GCA, and TNF inhibitors pose the highest risk of infection among the biologics studied.