P294 Improved relapse-free survival with the Norwich prednisolone regimen for giant cell arteritis

Abstract

Background/Aims Glucocorticoid therapy is the mainstay treatment for giant cell arteritis (GCA). There is no consensus on the dose of prednisolone to be used. Prednisolone regimens used in clinical trials have reported relapse rates of 66-92%. The long-term follow-up of tocilizumab and prednisolone for one year showed a relapse rate of 74% at two years. The Norwich Regimen is a bespoke prednisolone plan with an initial dose of 1mg/kg of lean body mass. It delivers 164.64 mg/kg of lean body mass in a logarithmic taper over 100 weeks. It was devised to reduce the risk of relapse and allow patients to be in control of their prednisolone reduction. Methods All patients were diagnosed by biopsy, ultrasonography or PET scan and provided with a printed prednisolone plan at diagnosis. All individuals were assessed at approximately 3-6 monthly intervals in addition to suspected relapse, toxicity or other need for course correction. Relapses were confirmed objectively using a modification of the Kerr criteria. Relapse free survival was recorded at 100 weeks. Patients were given an open invite to contact us in the event of a suspected relapse after coming off prednisolone. A notes review was done to record events at 150 weeks. Results 150 consecutive people with objectively diagnosed GCA (mean age 74) since 10/01/2012 have completed 150 weeks since starting prednisolone. Drug-free, relapse-free survival at 100 weeks was met by 133/150 (89%). Seven individuals died and 20 relapsed. A further five died and 15 relapsed by week 150; 103/150 (69%) survivors were in prednisolone-free remission. Of the 12 deaths, six died of cancer, one subdural haemorrhage, one ischaemic bowel, one septicaemia, and one general decline (aged 93). The cause of death was not available for two individuals who died in the community. The median time to relapse for the 35 individuals was 80 weeks (IQR 64,109). Conclusion We report the first results of a bespoke prednisolone taper to be used in real life. The Norwich Regimen for the treatment of GCA results in drug-free relapse-free survival of 89% at 100 weeks and 69% at 150 weeks, which is superior to all other reports published so far. Disclosure G. Ducker: None. K. Mills: None. C. Yong: None. C. Jones: None. C. Mukhtyar: None.