Combined Treatment of Giant-Cell Arteritis with Methotrexate and Prednisone

Abstract

Treatment with methotrexate plus corticosteroid is a safe alternative to corticosteroid therapy alone in patients with giant-cell arteritis and is more effective in controlling disease.

The Prediction and Monitoring of Toxicity Associated with Long-Term Systemic Glucocorticoid Therapy

“…In GCA patients receiving high-dose oral GCs, myopathy was listed as an AE in 3/39 patients in a 2-year trial [ 43 ] but in 0/27 patients in a 78-week trial [ 44 ]. Yet in a third trial, 20/21 GCA patients reported 'subjective muscle weakness' [ 45 ].…”

“…In two separate studies, 7/124 of PMR patients and 2/40 of RA patients receiving an average daily dose of 10 mg prednisolone/day developed DM [ 46 , 78 ]. Moreover, 7/19 of GCA patients on high-dose GCs developed DM, and a further 2/19 developed glucose intolerance [ 43 ]. High-dose GCs induced DM in 16/127 of patients with SLE [ 79 ].…”

Interleukin 6 Blockade as Steroid-sparing Treatment for 2 Patients with Giant Cell Arteritis: Figure 1.

“…For patients whose disease is resistant to or dependent on CS therapy, methotrexate (MTX) or azathioprine (AZA) is used as steroid-sparing second-line treatment, with conflicting results 3 . While MTX seems to be effective in controlling GCA 4,5 , the data on AZA remain controversial 6 ; the tumor necrosis factor-blocking agents infliximab and etanercept were not successful in inducing and maintaining disease remission 7,8 .…”

Sustained Remission: An Unmet Need in Patients with Giant-cell Arteritis

“…This percentage is somehow lower than that reported in previous studies. The highest relapse rates (76%-84.2%) have been described in clinical trials of adjuvant therapies where aggressive GC-tapering schedules designed to evidence the potential GC-sparing efficacy of the investigational product have been applied 3,4,5,6,8 . Outside clinical trials, reported frequencies in prospective observational studies range from 36% to 64% 10,11,12,13 .…”

“…In the majority of randomized controlled trials of GC-sparing agents, relapse, which is the essence of the primary endpoint, is defined by reappearance of specified GCA-related symptoms 3,4,5,6 . In some, but not in all of them, a concomitant increase in serum acute-phase reactants [usually erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)] is required.…”