Background: Giant cell arteritis (GCA) is a systemic vasculitis affecting older adults, often requiring prolonged glucocorticoid (GC) therapy. Interleukin-6 receptor inhibitors (IL-6Ri), such as tocilizumab and sarilumab, offer a promising steroid-sparing strategy with targeted anti-inflammatory action.

Objectives: To evaluate the efficacy and safety of IL-6Ri in inducing sustained remission, reducing GC exposure, and minimizing adverse events in patients with GCA.

Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Randomized controlled trials comparing IL-6Ri to placebo in adults with GCA were identified through comprehensive database searches up to April 2025 on PubMed, Scopus, Embase, and Web of Science. The primary outcome was sustained remission at 52 weeks. Secondary outcomes included cumulative corticosteroid use, adverse events (AEs), and serious adverse events (SAEs). Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model.

Results: Three trials with a total number of 364 patients were included. IL-6Ri significantly increased sustained remission rates at 52 weeks (RR = 2.52; 95% CI 1.65–3.85; p < 0.001; I ² = 0%). Tocilizumab showed a robust effect (RR = 2.61), while sarilumab demonstrated a non-significant trend (RR = 1.97). Cumulative corticosteroid doses were markedly reduced in IL-6Ri arms across all trials. IL-6Ri were not associated with a significant increase in AEs (RR = 1.02; p = 0.86) or SAEs (RR = 0.92; p = 0.75).

Conclusions: IL-6Ri significantly improve sustained remission and reduce GC burden in GCA without increasing serious adverse events. These agents represent an effective and safe option for modern GCA management, warranting broader clinical use and further research into long-term outcomes.

REFERENCES: [1] M. Villiger et al., “Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial,” Lancet, vol. 387, no. 10031, pp. 1921–1927, May 2016, doi: 10.1016/S0140-6736(16)00560-2.

[2] W. A. Schmidt et al., “A phase 3 randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of sarilumab in patients with giant cell arteritis,” Arthritis Res Ther, vol. 25, no. 1, p. 199, Oct. 2023, doi: 10.1186/s13075-023-03177-6.

Acknowledgments: NIL.

Disclosure of Interests: None declared.