Disease-modifying antirheumatic drugs for the management of takayasu arteritis – Protocol for a systematic review

Abstract

Takayasu arteritis (TAK) is a rare systemic large-vessel vasculitis. The evidence base to guide the medical management of TAK is sparse. This systematic review aims to synthesize the published literature on the use of disease-modifying antirheumatic drugs (DMARDs) in TAK. Scopus (which includes data from MEDLINE), Web of Science, PubMed central, the Cochrane Central Register of Controlled Trials (CENTRAL), and the World Health Organization International clinical trials registry platform shall be searched for relevant studies, both observational and interventional, on the use of DMARDs in TAK. Outcomes assessed shall be remission based on clinical, composite measures, inflammatory markers, angiographic assessment, and relapses. Screening of references and data extraction on predesigned pro formas shall be done in duplicate. Quality assessment of studies shall be done at the study level, using the Cochrane Risk of Bias 2 tool for interventional studies and the Newcastle–Ottawa scale for interventional studies. Publication bias shall be assessed wherever appropriate. Proportions of outcomes with DMARDs shall be pooled for uncontrolled observational studies. For controlled observational studies and interventional studies, pooled risk of outcomes versus comparator treatment or placebo shall be presented. Preplanned subgroup analyses are based on whether participants are adults or children with TAK. Certainty of evidence for DMARDs across studies shall be assessed by the GRADE profiler tool. The findings of the present systematic review shall help to understand better the current landscape of evidence for the use of DMARDs in TAK. This might help to guide future recommendations for the management of TAK. Future clinical trials on TAK might also be designed to avoid lacunae identified in the existing evidence for DMARD use on TAK.