Efficacy of leflunomide as a steroid‐sparing agent in treatment of Indian giant cell arteritis patients: A 2‐year follow‐up study

Das, Shyamashis; Goswami, Rudra Prosad; Sinha, Debanjali; Ghosal, Anirban; Datta, Anindita; Sarkar, Sonali

doi:10.1111/1756-185x.14319

Cited by 11 publications

(12 citation statements)

References 22 publications

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“…A recent prospective Indian observational study reported 22 patients newly diagnosed with cranial-only GCA with an add-on therapy with leflunomide to a predefined glucocorticoid regimen at week 0, demonstrating that the maintenance of continuous steroid-free remission was achieved in 68% of patients for a median follow-up period of 24 months ( 18 ). Seven (31.8%) patients in this cohort experienced a clinical relapse after a median of 12 months after initial remission, a rate significantly higher than in our cohort; however, due to the different design of the study and limited number of patients, a comparison is inapplicable.…”

Section: Discussionmentioning

confidence: 99%

Performance of leflunomide as a steroid-sparing agent in giant cell arteritis: A single-center, open-label study

et al. 2022

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BackgroundThe management of giant cell arteritis (GCA) remains challenging and many patients require prolonged glucocorticoid treatment due to high disease relapse rates. We aimed to evaluate the role of leflunomide as a steroid-sparing agent in GCA.MethodsThis prospective open-label study included patients diagnosed with GCA between July 2014 and August 2020 and followed them for 96 weeks. At the time of diagnosis all patients received treatment following a predefined glucocorticoid regimen. At week 12 of follow-up, 10 mg of leflunomide per day was recommended as an adjunctive therapy. The decision to start with leflunomide treatment was patient-dependent. Follow-up visits were performed adhering to a predetermined protocol. The number of relapses, the cumulative glucocorticoid dose and treatment-related adverse events were recorded and compared between glucocorticoid-only and leflunomide groups.ResultsOf the 215 GCA patients [67.6% female, median (IQR) age 74 (66–79) years], 151 (70.2%) received leflunomide at week 12 (leflunomide group); the others continued with glucocorticoids (glucocorticoid-only group). During the study 64/215 (29.8%) patients relapsed. Of the 51 patients who relapsed after 12 weeks, 22/151 patients (14.6%) and 29/64 patients (45.3%) were in the leflunomide and glucocorticoid-only group, respectively (p = 0.001; NNT 3.3 for leflunomide). Furthermore, 80/151 patients in the leflunomide group managed to stop glucocorticoids at week 48 [with relapses in 6/80 patients (7.5%)]. The cumulative glucocorticoid dose was lower in the leflunomide group (p = 0.009).ConclusionIn our cohort, leflunomide safely and effectively reduced the GCA relapse rate and demonstrated a steroid-sparing effect in over three quarters of patients.

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Section: Discussionmentioning

confidence: 99%

Performance of leflunomide as a steroid-sparing agent in giant cell arteritis: A single-center, open-label study

et al. 2022

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“…3 Non-glucocorticoid immunosuppressive agents (ie tocilizumab, methotrexate) can be used as adjunctive therapies in selected patients with GCA. 3,4 A recent prospective observational study by Das et al 5 showed the efficacy and safety of leflunomide as a steroid-sparing agent in patients with GCA.…”

Section: Backg Rou N Dmentioning

confidence: 99%

How beneficial and safe is tocilizumab for patients with giant cell arteritis? A Cochrane Review summary with commentary

Benlidayı

2022

Int J of Rheum Dis

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“…53 A 2-year prospective observational study by Das et al found that all patients treated with leflunomide and a corticosteroid taper exhibited a clinical improvement and 77% could stop corticosteroids completely. 54 In fact, a recent retrospective study investigating 10 years' worth of medical records of patients with GCA from the United Kingdom found that patients who received leflunomide adjunctive therapy had better clinical outcomes than those who received corticosteroids alone. 55 Thus, leflunomide has shown potential as an adjunctive therapy in GCA, but RCTs are necessary to further assess and confirm the efficacy of leflunomide as a corticosteroid-sparing agent in GCA.…”

Section: Leflunomidementioning

confidence: 99%

Immunosuppressive Therapy in Giant Cell Arteritis: Do Steroids Still Reign Supreme?

Zhao¹,

Dhanani²,

Charoenkijkajorn³

et al. 2022

US Ophthalmic Review

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Giant cell arteritis (GCA) is the most common vasculitis in adults, and patients with GCA often present with vision loss that may progress to permanent blindness. For this reason, empirical treatment with corticosteroids is initiated when there is reasonable suspicion of GCA. Corticosteroids have remained the mainstay of treatment for GCA for the past 70 years due to their profound immunosuppressive effects. However, not all patients tolerate or respond adequately to corticosteroids, and prolonged dosages increase the risk for adverse side effects. There have also been recent advances and investigations into alternative immunosuppressive therapies for GCA; specifically, interleukin 6 inhibitors and other alternatives have been approved by the American College of Rheumatology and European League Against Rheumatism for adjunctive use with corticosteroids or for refractory GCA. However, it is unclear whether current immunosuppressive alternatives can conclusively replace corticosteroids in the treatment of GCA and prevention of vision loss. This article reviews the robust immunosuppressive mechanisms of corticosteroids and summarizes clinical investigations of alternative therapies for GCA.

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Efficacy of leflunomide as a steroid‐sparing agent in treatment of Indian giant cell arteritis patients: A 2‐year follow‐up study

Cited by 11 publications

References 22 publications

Performance of leflunomide as a steroid-sparing agent in giant cell arteritis: A single-center, open-label study

Performance of leflunomide as a steroid-sparing agent in giant cell arteritis: A single-center, open-label study

How beneficial and safe is tocilizumab for patients with giant cell arteritis? A Cochrane Review summary with commentary

Immunosuppressive Therapy in Giant Cell Arteritis: Do Steroids Still Reign Supreme?

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