Background/Purpose:
Systemic glucocorticoid (GC) therapy is the first line treatment for giant cell arteritis (GCA). Patients with GCA are often counseled that therapy will be needed for 1 to 2 years, but in recent years it has been recognized that GCA is a chronic disease requiring long-term therapy and monitoring. We sought to evaluate the duration and cumulative dose of GC therapy in a population based cohort of patients with GCA diagnosed 1980-2004 compared with 1950-1979.
Methods:
We retrospectively reviewed a population-based incidence cohort of GCA patients diagnosed between 1950 and 2004. All subjects were longitudinally followed through all available community medical records until death, migration or December 31, 2009. Data was collected regarding dosing and duration of GC use. Kaplan-Meier methods were used to estimate the time to discontinuation of GC and log rank tests were used for comparisons between time periods.
Results:
The study population included 204 patients. Mean age was 76 years and 163 (80%) were female. Median follow-up was 8.8 years with 1,996 total person-years. Mean erythrocyte sedimentation rate at diagnosis was 79.2 mm/hr. Temporal artery biopsy was positive in 176 (86%) patients.
The mean starting dose of prednisone was 53.2mg/day in 1980-2004 and 54.8 mg/day in 1950-1979 (p=0.79). Prednisone dose of <10 mg/day for 6 months was reached in 34%, 81% and 98% patients by 1, 2 and 5 years from GCA incidence date respectively in patients diagnosed between 1980-2004 compared to 52%, 88% and 100% respectively among patients in the 1950-1979 cohort (p=0.003). In the 1980-2004 cohort, only 14% permanently discontinued GC use by 1 year from GCA incidence date, 41% by 2 years and 75% by 5 years compared to 40%, 64% and 76% respectively in the 1950-1979 cohort (p=0.032).
The median time to reach a prednisone dose of <10mg/day was about 6.5 months in 1980-2004 versus 3.2 months in 1950-1979 (p <0.001). The mean cumulative dose of prednisone by 1 year after incidence of GCA was 6.1 gm in 1980-2004 versus 4.1 gm in 1950-1979 (p < 0.001). Mean cumulative dose by 5 years was 10.3 gm in 1980-2004 versus 7.8 gm in 1950-1979 (p=0.007).
Conclusion:
Patients diagnosed with GCA in recent decades were on GC for a longer duration and received higher cumulative doses. As well, a significantly higher proportion of patients remain on GC therapy even beyond 5 years following diagnosis. The reasons for the secular trend in longer duration and higher doses of GC for treating GCA are unclear, but may relate to recognition that GCA a more chronic disease with late sequelae such as large vessel disease than previously recognized, increasing the concern for GC associated adverse effects in these patients.
Disclosure:
P. D. Udayakumar,
None;
T. A. Kermani,
None;
K. J. Warrington,
None;
C. S. Crowson,
None;
E. L. Matteson,
Centocor, Inc./Johnson and Johnson,
2,
Genentech and Biogen IDEC Inc.,
2,
Hoffmann-La Roche, Inc.,
2,
Human Genome Sciences, Inc.,
2,
Pfizer Inc,
2,
Novartis Pharmaceutical Corporation,
2,
Roche Pharmaceuticals,
2,
UCB Group,
2,
Centocor, Inc.,
5,
Horizon Pharma,
5,
Novartis Pharmaceutical Corporation,
5.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increase-in-duration-and-cumulative-dose-of-glucocorticoid-therapy-in-recent-decades-observations-from-a-population-based-cohort-of-patients-with-giant-cell-arteritis/