Background/Purpose: Giant-cell arteritis (GCA) is the most common primary large-vessel vasculitis affecting patients over 50 yr. Despite frequent and severe adverse events (AEs), glucocorticoids (GCs) are the reference treatment.¹ In 2003, Proven et al reported GC-related AEs) in 86% of their patients.² Efficacy of immunosuppressants, specifically methotrexate, is modest. Although tocilizumab is emerging as an alternative agent, the long-term benefit of IL6 blockade is unknown. Moreover, application of the most recent recommendations on GC-induced osteoporosis or vaccinations might change the GC-associated risks and, thus, the risk/benefit balance needs to be updated. We evaluated the GC-induced frequencies of AEs in a French cohort of GCA patients.

Methods: This retrospective study was conducted in 2 French hospitals. GCA was diagnosed between May 2009 and March 2018, based on ACR criteria or the diagnostic criteria used in the GIACTA trial. GC-associated AEs and prophylaxis against infection, osteoporosis and gastrointestinal bleeding were recorded at each outpatient consultation.

Results: The cohort comprised 89 women and 27 men; median age 73 [IQR 67–79] years. The median number of ACR criteria met/patient was 3 [IQR 3–4]. Temporal artery biopsies were positive for 63% and 34% had imaging-revealed aortitis. All took GCs for a median duration of 22 |IQR 18–32] months, with tapering to 5 mg/day achieved after 10 [IQR 8–14] months. At the end of follow-up, 36 patients (31%) were still taking GCs. Among the other 69% who had stopped GCs after 21.5 [IQR 18–28] months, 13 relapsed. Median follow-up was 29 [IQR 19.5–47] months (369 patient/years). Patients were also taking bisphosphonates (79%), calcium (79%), vitamin D (87%) and/or proton-pump inhibitors (51%) and 36% had been vaccinated against pneumococci and/or flu. AEs occurred in 66 (57%) patients, including bone fractures in 22%, diabetes mellitus onset in 1%, gastrointestinal bleeding in 1%, hypertension in 10%, infections in 10%, and cataract(s) in 7%. Thirty-seven (32%) patients received GC-sparing therapy: methotrexate for 32, tocilizumab for 10 and azathioprine for 1; those agents were mainly initiated at the time of relapses/flares (49%).

Conclusion: GC-related AEs were less frequent in this cohort of GCA patients than Proven’s cohort, perhaps explained by measures taken to prevent them or our study’s retrospective design. Although alternative options to GC are important, the exact place of new therapies should also take into account better prevention of GC-related AEs.

References:

1. Dejaco C et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2015;74:1799–807

2. Proven A et al. Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Rheum 2003;49:703–8.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/giant-cell-arteritis-is-glucocorticoid-sparing-treatment-still-relevant-a-retrospective-study/