Background/Purpose: The aim of this study was to estimate the timing of relapse, the prevalence of multiple relapses and the predictors of relapse in patients with giant cell arteritis (GCA).

Methods: PubMed, Embase and Cochrane databases were searched from inception till November, 30 2021. Outcome measures include cumulative relapse rate (CRR) of first relapse at year 1, 2, and 5 after treatment initiation, CRR of second and third relapse and predictors of relapse. A random-effects model was used.

Results: Thirty studies (2595 patients) were included for timing of relapse, 16 studies (1947 patients) for prevalence of multiple relapses and 40 studies (4213 patients) for predictors of relapse. One-year, 2-year and 5-year CRRs were 32.0% [95% CI 22.4 – 43.6%], 44.3% [95% CI 30.5 – 59.1%], and 46.6% [95% CI 27.2 – 67.1%], respectively. The duration of scheduled glucocorticoid therapy was negatively associated with the 1-year CRR (p = 0.05). CRR of second and third relapse were 29.6% [95% CI 20.6 – 40.0] and 16.9% [95% CI 8.0 – 32.5%], respectively. Female sex (OR 1.43) and large vessel involvement (OR 2.04) were predictors of relapse.

Conclusion: Relapse occurred in almost half of GCA patients mainly during the first two years after diagnosis. One in three patients had multiple relapses. The optimal glucocorticoid tapering schedule, which seeks a balance between the lowest relapse risk and the shortest glucocorticoid duration, needs to be determined in future studies. Longer scheduled glucocorticoid therapy or early introduction of glucocorticoid-sparing agents may be warranted in female patients and patients with large vessel involvement.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/epidemiology-and-predictors-of-relapse-in-giant-cell-arteritis-a-systematic-review-and-meta-analysis/