Background/Purpose:

The high-dose glucocorticoids (GCs) are the mainstay of treatment in Giant Cell Arteritis (GCA). Patients treated with greater GC dosages are at the greatest risk of morbidity. Immunosuppressive agents have been trialled in an effort to reduce toxicity from GCs and to improve efficacy of treatment. The results of one meta-analysis with the three trials that included methotrexate (MTX) showed a weak benefit in those patients receiving MT), but the results were heterogeneous, with one trial showing significant benefit, while the other two did not (1). In this sense, our main objective was to study the efficacy and safety of MTX adjunct to GCs in the treatment of GCA.

Methods:

New-onset giant-cell arteritis initiating treatment of the disease was included in a retrospective observational study to compare treatment efficacy and safety. According to the treatment received the patients were divided two groups: a) GCs alone and b) MTX and GCs. To avoid bias, in group b, only patients who started MTX in the first trimester of treatment were included. As efficacy outcome the number of relapses and the cumulative dose of GCs at 6, 12 and 24 months were collected. For safety, the number of emergency room visits, hospitalization admissions and treatment related side adverse events were investigated in the follow-up.

Results:

Among the 147 patients included in the study, 64 (43.5%) received GCs alone (mean age 78.6±7.5 years) and 83 (56.5%) received GCs and MTX as an adjuvant treatment at some time during follow-up. 52 of these 83 patients (mean age 78.5±8.0 years) received MTX in the first trimester after diagnosis (group b). In the MTX group 43 patients received a dose of 7.5-15mg/week and 9 patients received a dose ≥15mg/week. Compared with only GCs treatment, MTX introduced in the first three months therapy did not reduce the rate of relapses, 51% in MTX group vs. 37.7% in the GCs group (p<0.09). The mean cumulative dose of prednisone was higher in the MTX group than in prednisone alone group (table). Patients in the MTX group, at any dose, presented a higher incidence of hospital admissions and hospital admissions by infections (p<0.05).

Conclusion:

Whilst MTX have been used in an effort to reduce toxicity from GCs and to improve efficacy of treatment our observational study shows that there is no benefit from adjunct MTX in GCA either in terms of efficacy or toxicity.

(1) Mahr AD, Jover JA, Spiera RF et al. Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data metaanalysis. Arthritis Rheum 2007; 56(8):2789–2797.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/metotrexate-in-the-treatment-of-giant-cell-arteritis-to-be-or-not-to-be/