Background/Purpose:

Corticosteroid related adverse events are a main concern in patients suffering from giant cell arteritis. Conflicting results are reported on this topic, recurrent events are usually not taken into account and direct comparisons with the general population are scarce. We investigated non-cardiovascular corticosteroid related adverse events and cancer risks in an incident GCA patients cohort, the Midi-Pyrénées (southwest France) APOGEE cohort.

Methods:

APOGEE is an administrative database cohort of 103 incident GCA patients (median age : 77 [51-91] years ) and 606 age- and sex-matched controls included between January 2005 and December 2008. The risk of events was compared between patients and controls during the first 36 months of follow-up using Cox models for single events and a linear negative binomial regression model for multiple events (infections and hospitalizations). Generalized estimating equations were used to compare the risk of occurrence across 6-months time periods.

Results:

More than 1 Charlson comorbidity was present before diagnosis in 35% and 46,6% of GCA and control patients, respectively (p=0,03). The hazard ratios (HR) and incidence rate ratios (IRR) of main events are reported in table 1. The risk of any corticosteroid-related events was increased by 49.6% in GCA patients, but it was significant only during the 24 months following diagnosis of GCA. Recurrent (≥2) infections occurred in 61.2% of GCA patients versus 46.7% (p<0.001). The rate ratio of infections was increased and stable throughout the follow-up. Age over 75 years and sex were not significantly associated with the risk of infection but suffering ≥1 comorbidity was (IRR = 1.187, p<0.01). Infection was the main cause of hospitalization in GCA patients. The risk of hospitalization for any cause (excluding the first hospitalization corresponding to GCA diagnosis) was increased (50.5% vs 35,5%, p<0,001) and repeated hospitalizations were more frequent (p<0.001) in GCA patients. Presence of comorbidities was the sole independent predictor of the risk of hospitalization. The initial prednisone dose (<60 mg prednisone vs ≥ 60 mg/d) was not associated with the occurrence of any adverse event.

Conclusion:

Muskuloskeletal events were rare in the setting of osteoporosis prevention. Overall, the risk of serious (leading to hospitalization) or repeated infections is a concern. The increased risk of cancer was unexpected.

Table 1 : risk of new corticosteroid related events and cancer in GCA patients (compared to age and sex matched controls).

ACR Meeting Abstracts - https://acrabstracts.org/abstract/risks-of-non-cardiovascular-corticosteroid-related-adverse-events-and-cancer-in-giant-cell-arteritis-a-french-population-based-cohort-study/