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.