Evaluation of Adjunctive Mycophenolate for Large Vessel Giant Cell Arteritis

M Karabayas* (Corresponding Author), P Dospinescu, N Fluck, D Kidder, G Fordyce, RJ Hollick, C de Bari, N Basu

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objectives:
GCA patients with large vessel involvement (LV-GCA) experience greater steroid requirements and higher relapse rates, compared to classical cranial GCA. Despite the distinct disease course, interventions in LV-GCA have yet to be specifically investigated. This study aimed to evaluate the steroid sparing effect and tolerability of first-line mycophenolate in LV-GCA.
Methods:
A retrospective cohort study was conducted in patients with LV-GCA identified from a regional clinical database between 2005 and 2019. All cases were prescribed mycophenolate derivatives (mycophenolate mofetil or mycophenolic acid, MYC) at diagnosis and were followed up for at least 2 years. The primary outcome was cumulative steroid dose at 1 year. Secondary outcomes included MYC tolerance, relapse rates and CRP levels at 1 and 2 years.
Results:
A total of 37 patients (65% female; mean age 69.4, SD7.9) were identified. All cases demonstrated large vessel involvement via CT/PET n=34, CTA n=5 or MRA n=2. After 2 years, 31 patients remained on MYC, whilst 6 switched to methotrexate or tocilizumab due to significant disease relapse. The
mean cumulative prednisolone dose at 1 year was 4960 (±1621) mg. Relapse rates at 1 and 2 years were 16.2% and 27% respectively, whilst CRP levels at 1 and 2 years were 4 mg/L (IQR 4-6 mg/L) and 4 mg/L (IQR 4-4 mg/L) respectively.
Conclusion:
To our knowledge, this is the first effort to assess the effectiveness of any specific agent in LV-GCA. MYC may be both effective in reducing steroid exposure and well tolerated in this sub-population. A future randomised controlled trial is warranted.
Original languageEnglish
JournalRheumatology Advances in Practice
Publication statusAccepted/In press - 11 Oct 2020

Keywords

  • Large vessel vasculitids
  • giant cell arteritis
  • mycophenolate
  • steroid sparing
  • relapse rate

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