Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: Glucocorticoids have been the mainstay treatment of giant cell arteritis (GCA) for decades. Recently, tocilizumab has been proven to be an effective alternative to glucocorticoid. However, not all GCA patients are eligible for biologics. We aimed to evaluate the role of leflunomide as a steroid sparing agent in GCA.
Methods: This open label study included newly diagnosed GCA patients followed at least 48 weeks at a single secondary/tertiary rheumatology centre. At the time of diagnosis patients received glucocorticoid, in line with the EULAR recommendations. At week the 12 of follow up (FU), leflunomide 10 mg qd was recommended as an adjunctive therapy to all patients without known contraindications. The final decision to start the leflunomide was patient dependent. At week 48 we planned to stop glucocorticoid in leflunomide group. The number of relapses, a cumulative glucocorticoid dose during follow-up and treatment related adverse events (AE) were recorded and compared between glucocorticoid-only and leflunomide groups.
Results: Seventy-six patients (65.8% female, median (IQR) age 73.7 (66.1–78.8) years) were followed for a median (IQR) 96 (86–96) weeks. Thirty out of 76 patients (39.5%) received leflunomide at week 12 (leflunomide group), the others continued treatment with glucocorticoid (glucocorticoid-only group). During the first 48 weeks of FU, 22 patients relapsed, 4 in leflunomide group (13.3%) and 18 (39.1%) in glucocorticoid-only group. The difference was statistically significant (p=0.02; NNT 3.9 (95%CI 2.2-17.4)). Furthermore, 17/30 patients (56.7%) in the leflunomide group managed to stop glucocorticoid at week 48 (with one relapse (5.9%) shortly afterwards). The cumulative glucocorticoid dose at the last visit was lower in the leflunomide group than in the glucocorticoid only group (4,390 (4,132–5,558) mg, vs. 5,340 (4,652–5,792) mg, p=0.01). The patients tolerated leflunomide relatively well. Eight out of 30 patients (26.7%) discontinued leflunomide (one due to ineffectiveness and seven due to AE).
Conclusion: Our findings indicate the steroid sparing effect of leflunomide in GCA.
To cite this abstract in AMA style:Hočevar A, Jese R, Rotar Z, Tomšič M. Does Leflunomide Have a Role in Giant Cell Arteritis? [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/does-leflunomide-have-a-role-in-giant-cell-arteritis/. Accessed September 19, 2021.
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