Stratified glucocorticoid monotherapy is safe and effective for most cases of giant cell arteritis

M. Karabayas* (Corresponding Author), P. Dospinescu, M. Locherty, P. Moulindu, M.M. Sobti, R. Hollick, C. de Bari, S. Robinson, J. Olson, N. Basu

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objectives

High dose glucocorticoids anchor standard care in giant cell arteritis (GCA) but are associated with significant toxicity. We aimed to evaluate the safety and effectiveness of a stratified approach to glucocorticoid tapering. The strategy aggressively reduced glucocorticoid doses in those manifesting an adequate early response to treatment with view to minimising glucocorticoid complications.

Methods

A retrospective, population-based study of GCA was performed. All cases were confirmed by temporal artery biopsy between November 2010 and November 2015. Baseline and outcome data were extracted from secondary and primary care records at diagnosis and 1 year. The primary outcome was loss of vision. Secondary outcomes included remission and relapse rates as well as corticosteroid related complications.

Results

The cohort consisted of 73 patients (76% female; mean age 73.5, SD 7.6). At presentation reduction in visual acuity (VA) was recorded in n=17 (22.3%). Median CRP at diagnosis was 69.5mg/L (IQR 40.5-101mg/L) with median ESR 80mm/h (IQR 60-91mm/hr). At 1 year, remission was achieved in n=64 (87.7%) and n=10 (13.7%) relapsed. A single patient sustained visual loss following initiation of therapy. Median CRP at 1 year was 4mg/L (IQR 4-9.5mg/L) and mean Prednisolone dose was 5.4mg (0-15mg). Steroid related complications were observed in n=10(13.7%).

Conclusion

A stratified approach to corticosteroid tapering appeared safe and effective in GCA. It was associated with high rate of remission and promisingly low rates of relapse following 1 year follow up. This real-world data indicates glucocorticoid exposure can be safely minimised in some patients with GCA.
Original languageEnglish
JournalRheumatology Advances in Practice
Publication statusAccepted/In press - 27 May 2020

Keywords

  • giant cell arteritis
  • temporal artery biopsy
  • retrospective cohort
  • glucocorticoid
  • tapering regimens
  • visual loss
  • remission
  • relapse

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