Systematic Review and Meta-Analysis for JCS 2026 Guideline on Management of Large-Vessel Vasculitis
Abstract
BACKGROUND: To provide evidence from randomized controlled trials (RCTs) for large-vessel vasculitis (LVV), including Takayasu arteritis (TAK) and giant cell arteritis (GCA), to inform the forthcoming 2026 Japanese Circulation Society (JCS) clinical practice guideline. METHODS AND RESULTS: We drafted 4 and 7 clinical questions for TAK and GCA, respectively. A systematic review (SR) of RCTs was conducted using PubMed, CENTRAL, EMBASE, and the Japan Medical Abstracts Society through March 2024. Assessed with the GRADE approach, the certainty of evidence was very low for the most critical outcomes, low for some outcomes, and moderate for only 1 outcome. Evidence for TAK was limited. Tocilizumab (TCZ) resulted in a numerically lower relapse rate vs. placebo (risk ratio (RR) 0.73, 95% confidence interval (CI) 0.39-1.37) and was similar to adalimumab. No clear difference between mycophenolate mofetil (MMF) and methotrexate (MTX), or between abatacept (ABA) and placebo was observed. In GCA, TCZ reduced relapse (RR 0.29, 95% CI 0.09-0.98) and increased remission (RR 3.56, 95% CI 2.29-5.54) over placebo at 52 weeks. Tumor necrosis factor inhibitor, ABA, and MTX showed no benefit in cranial GCA. Serious adverse events were comparable between treatment groups. Geographic variation and differences in entry criteria were noted. CONCLUSIONS: This SR was comprehensive synthesis of evidence from RCTs for LVV therapies to support the 2026 JCS guideline.
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BibTeX
@article{shirai2026systematic,
title = {{Systematic Review and Meta-Analysis for JCS 2026 Guideline on Management of Large-Vessel Vasculitis}},
author = {Tsuyoshi Shirai and Tsuneyasu Yoshida and Eri Sugano and Ryosuke Hiwa and Ryuhei Ishihara and Ryo Yanai and Nobuyuki Yajima and Takashi Kida and Norihiro Nishioka and Ryota Sakai and Takaya Handa and Manabu Honda and Jun Ishizaki and Keiichiro Kadoba and Yuji Kamiyama and Genki Kidoguchi and Takatoyo Kiko and Daisuke Kobayashi and Kazuhiro Kobayashi and Shun Nakagama and Yu Nakano and Hajime Sanada and Shin-ya Tamechika and Jin Ueda and Kenji Nagasaka and Takahiko Sugihara and Naoto Tamura and Yoshikazu Nakaoka},
journal = {Circulation Journal},
year = {2026},
month = sep,
doi = {10.1253/circj.cj-25-1129},
url = {https://www.jstage.jst.go.jp/article/circj/90/10/90_CJ-25-1129/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Systematic Review and Meta-Analysis for JCS 2026 Guideline on Management of Large-Vessel Vasculitis
AU - Tsuyoshi Shirai
AU - Tsuneyasu Yoshida
AU - Eri Sugano
AU - Ryosuke Hiwa
AU - Ryuhei Ishihara
AU - Ryo Yanai
AU - Nobuyuki Yajima
AU - Takashi Kida
AU - Norihiro Nishioka
AU - Ryota Sakai
AU - Takaya Handa
AU - Manabu Honda
AU - Jun Ishizaki
AU - Keiichiro Kadoba
AU - Yuji Kamiyama
AU - Genki Kidoguchi
AU - Takatoyo Kiko
AU - Daisuke Kobayashi
AU - Kazuhiro Kobayashi
AU - Shun Nakagama
AU - Yu Nakano
AU - Hajime Sanada
AU - Shin-ya Tamechika
AU - Jin Ueda
AU - Kenji Nagasaka
AU - Takahiko Sugihara
AU - Naoto Tamura
AU - Yoshikazu Nakaoka
PY - 2026
DA - 2026/09/25
JO - Circulation Journal
DO - 10.1253/circj.cj-25-1129
UR - https://www.jstage.jst.go.jp/article/circj/90/10/90_CJ-25-1129/_article
AB - BACKGROUND: To provide evidence from randomized controlled trials (RCTs) for large-vessel vasculitis (LVV), including Takayasu arteritis (TAK) and giant cell arteritis (GCA), to inform the forthcoming 2026 Japanese Circulation Society (JCS) clinical practice guideline. METHODS AND RESULTS: We drafted 4 and 7 clinical questions for TAK and GCA, respectively. A systematic review (SR) of RCTs was conducted using PubMed, CENTRAL, EMBASE, and the Japan Medical Abstracts Society through March 2024. Assessed with the GRADE approach, the certainty of evidence was very low for the most critical outcomes, low for some outcomes, and moderate for only 1 outcome. Evidence for TAK was limited. Tocilizumab (TCZ) resulted in a numerically lower relapse rate vs. placebo (risk ratio (RR) 0.73, 95% confidence interval (CI) 0.39-1.37) and was similar to adalimumab. No clear difference between mycophenolate mofetil (MMF) and methotrexate (MTX), or between abatacept (ABA) and placebo was observed. In GCA, TCZ reduced relapse (RR 0.29, 95% CI 0.09-0.98) and increased remission (RR 3.56, 95% CI 2.29-5.54) over placebo at 52 weeks. Tumor necrosis factor inhibitor, ABA, and MTX showed no benefit in cranial GCA. Serious adverse events were comparable between treatment groups. Geographic variation and differences in entry criteria were noted. CONCLUSIONS: This SR was comprehensive synthesis of evidence from RCTs for LVV therapies to support the 2026 JCS guideline.
SN - 1347-4820
SN - 1346-9843
ER -