Background High glucocorticoids doses represent the standard of care in Giant Cell Arteritis (GCA)1.
Objectives The aim of the study was to assess the disease course and the adverse events in GCA patients treated with corticosteroids alone or in association with immunosuppressive drugs.
Methods 47 consecutive patients with GCA, treated with conventional therapy (steroids) or with combined therapy (Methotrexate+steroids or Cyclophosphamide+steroids) were analyzed. Disease relapses (defined as recurrence of clinical symptoms and increasing of inflammation markers) and adverse events were evaluated for a mean follow-up of 30.8 months (range 12-131).
Results Twenty-four patients (51.1%) were conventionally treated with glucocorticoids only, 12 (25.5%) with MTX+steroids, 11 (23.4%) with CYC+steroids. Patients treated with steroids only (“steroid”) showed more disease relapses than those treated with immunosuppressive drugs (“CYC-MTX”) (41.7% in “steroids” vs 13% in “CYC-MTX”, p=0.049). The steroid starting dose was less than 1 mg/kg/day prednisone equivalents in 21.7% of patients in the “MTX-CYC” group. The minimum steroid maintenance dose (5 mg/day of prednisone equivalents) was obtained in a mean time of 5.3±4.2 months in the “CYC-MTX” and in 10.4±6.6 months in the “steroids” (p=0.005). The adverse events recorded were two cases of pneumonia in “CYC” and one case of transaminasitis in “MTX”. The number of glucocorticoids side-effects were 19 in the “steroids” and 3 in the “CYC-MTX” subgroup.
Conclusions Immunosuppressive drugs (CYC or MTX) combined with steroids, in GCA patients, could lower the risk of disease relapses and the steroid exposure and side effects, without increasing adverse events.
Mukhtyar C et al. European Vasculitis Study Group. EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2009;68:318-23.
Disclosure of Interest None declared