Table 1: Agents used for steroid-sparing in GCA treatments.

Serial No. Steroid Sparing Agent Levels of Evidence Recommendation as a Steroid-Sparing Agent in GCA
1 Methotrexate IB Second line agent
2 Mycophenolate IIIC Third line agent
3 Azathioprine IIIC Third line agent
4 Cyclophosphamide IIIC Third line agent
5 Anti-TNF agents IB Etanercept can be used as second-line agent for induction of remission for corticosteroid refractory GCA)
6 Abatacept (Selective T-cell co-stimulation modulator) IB Can be an option as Third-line but larger studies required
7 Tocilizumab (IL6R-antagonist) IA First line agent (most robust evidence available)

*Levels of evidence: I-Systematic review of all relevant RCT’s or an n=1RCT, II-Randomised trial or observational study with dramatic effect, III-Non-randomised controlled cohort/follow up study(observational), IV- Case-series, case-control studies, or historically controlled studies, V- mechanism-based reasoning (expert opinion, based on physiology, animal or laboratory studies).
*Grades: A- consistent level I studies, B- Consistent level II or III studies or extrapolations from level I studies, C- level IV studies or extrapolations from level 2 or 3 studies, D- level V evidence or troubling inconsistent or inconclusive studies of any level.

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