Background After the advent of methotrexate, there are not comparative studies between different regimes of prednisone in giant cell arteritis (GCA). Due the complications of an excessive prednisone cumulative dose1, a prednisone maintenance dose≤7.5 mg/day is recommended2.
Objectives To compare the efficacy and safety of a medium (≤30 mg/day, group A) and a high (>30 mg/day, group B) prednisone starting dose and to identify factors related to remission taking a safe maintenance dose.
Methods Retrospective study including all patients with GCA of our unit between 2004 and 2012. Standard treatment was methylprednisolone pulses followed by prednisone as monotherapy or combined with methotrexate based on clinical criteria. The primary end-point was time to clinical and biological remission together with a prednisone maintenance dose≤7.5 mg/day. A Cox regression was performed to assess factors related to the primary end-point.
Results 103 patients (A:53, B:50) were followed for 3.3±2.1 years. Both groups exhibited similar baseline features including methotrexate combination except for visual symptoms (A:11, B:24 patients). Patients in group A had a shorter time to primary end-point (log-rank test, p=0.01) without resulting in an increase in relapses (A:21, B:25 patients, p=0.29) or disease-related complications (A:6, B:9 patients, p=0.33). There was a difference in the prednisone cumulative dose at 6 months (A:2.4±0.7, B:3.8±1.8 grams, p<0.01) that was related to a higher number of adverse effects (A:24, B:33 patients, p=0.03). Factors related to the primary end-point were lymphoplasmacytic infiltrate in the temporal artery biopsy (HR=0.55, p=0.01), induction with methylprednisolone pulses (HR=1.97, p=0.01) and occurrence of adverse effects (HR=0.48, p<0.01).
Conclusions In patients with GCA, a medium (≤30 mg/day) prednisone starting dose is at least as effective as and safer than a high (>30 mg/day) starting dose. Inflammatory signs in temporal artery, lack of methylprednisolone pulses and development of adverse effects may be related to a worse therapeutic response.
Nesher G, et al. Efficacy and adverse effects of different corticosteroid dose regimens in temporal arteritis: a retrospective study. Clin Exp Rheumatol 1997;15:303-6.
Hoes JN, et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 2007;66:1560-7.
Disclosure of Interest: None Declared
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