Prevalence of Giant Cell Arteritis Relapse in Patients Treated With Glucocorticoids: A Meta‐Analysis

Mainbourg, Sabine; Addario, Alexandra; Samson, Maxime; Puéchal, Xavier; François, Mathilde; Durupt, S.; Gueyffier, François; Cucherat, Michel; Durieu, I.; Reynaud, Quitterie; Lega, Jean‐Christophe

doi:10.1002/acr.23901

Cited by 77 publications

(45 citation statements)

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“…The absence of difference between the groups regarding the rate of fragility fractures may be due to the large use of bisphosphonates along with calcium and vitamin D supplementation as bone protection prophylactic treatment, usually employed in this setting. Notably, despite the more rapid deescalating steroid schedule in GCA-IT group, the relapses remained significantly lower in that group than in GCA-control group, and it was even lower than that reported by a recent meta-analysis [ 20 ], thus underlying the early synergic immunosuppressive effect of IT with GC, starting from the first month, when the dosage of immunosuppressive therapies is appropriate. In fact, while the rapid effect of cyclophosphamide or tocilizumab is known, for methotrexate, reaching the maximum well-tolerated dosage, i.e.…”

Section: Discussionmentioning

confidence: 55%

“…At present, comorbidity such as hypertension, venous thrombosis or diabetes at diagnosis, or systemic or local signs of much more inflamed disease (i.e. fever, anaemia or histological signs of more active disease) may predict relapse in GCA [ 18 , 29 , 30 ], which is much more frequent in the first year of treatment [ 20 ]. Indeed, no valid biomarkers have been found to predict which patients are at most risk for developing GC resistance in GCA [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Treatment strategy introducing immunosuppressive drugs with glucocorticoids ab initio or very early in giant cell arteritis: A multicenter retrospective controlled study

Quartuccio

Isola

Bruno

et al. 2020

Journal of Translational Autoimmunity

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Objective Glucocorticoids (GC) are associated with side effects in giant cell arteritis (GCA). Immunosuppressive therapies (ITs) have given conflicting results in GCA, regarding GC sparing effect. Primary endpoint is to evaluate whether very early introduction of ITs in GCA minimize the rate of GC-induced adverse events, in terms of infections, new onset systemic arterial hypertension, GC-induced diabetes and osteoporotic fractures. Methods A multicenter retrospective case-control study included 165 patients. One group included 114 patients who were treated with at least one IT given at diagnosis or within 3 months from the start of GC. A second group included 51 GCA who received only GC or an IT more than 3 months later. Results The most frequently used ITs were: methotrexate (138 patients), cyclophosphamide (48 patients) and tocilizumab (27 patients). No difference was observed as concerns the follow-up time between groups [48.5 (IQR 26–72) vs 40 (IQR 24–69), p = 0.3)]. The first group showed a significantly lower incidence of steroid-induced diabetes (8/114, 7% vs 12/51, 23.5%; p = 0.003) and no differences for the rate of infections (p = 0.64). The group was also exposed to lower doses of GC at first (p < 0.0001) and third (p < 0.0001, rank-sum test) month. Forty-four patients in the first group (38.6%) compared with 34 in the second one (66.7%) experienced at least one relapse (p = 0.001). Conclusion Very early introduction of IT in GCA lowered the incidence of steroid-induced diabetes, possibly due to the lower doses of GC in the first three months. Relapse rate was even lower.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Treatment strategy introducing immunosuppressive drugs with glucocorticoids ab initio or very early in giant cell arteritis: A multicenter retrospective controlled study

Quartuccio

Isola

Bruno

et al. 2020

Journal of Translational Autoimmunity

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“…Relapses are frequent during tapering and after cessation of treatment for GCA. Up to half of patients with GCA treated with glucocorticoids alone have at least one relapse 133 . During the first year of the GiACTA trial, 36 out of 149 (24%) patients receiving glucocorticoids plus tocilizumab had a flare, in comparison with 59 out of 101 (58%) receiving glucocorticoids plus placebo 46 .…”

Section: Tapering Treatments and Managing Relapsesmentioning

confidence: 99%

Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica

et al. 2020

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Giant cell arteritis (GCA) is the most common type of primary vasculitis in Western countries 1,2. Polymyalgia rheumatica (PMR) is the second most common inflammatory rheumatic disease of the elderly after rheumatoid arthritis (RA) 3. The two diseases are interrelated: 40-60% of patients with GCA have symptoms of PMR 3 , and histological features consistent with GCA have been found in 16-21% of temporal artery biopsy samples from patients with PMR 3. Most of these patients with PMR, however, presented with additional features of GCA, whereas the prevalence of positive histology in unselected patients with PMR is unknown. Both GCA and PMR are heterogeneous diseases. Although systemic manifestations (such as fever, malaise and weight loss) are common in both diseases, they are not present in all patients 4-6. Up to 1 in 5 patients with GCA with ocular involvement can present without systemic manifestations of the disease 7. GCA is the most common form of large-vessel vasculitis (LVV) and has a broad spectrum of disease manifestations, which are frequently overlapping. In the majority of cases, cranial and extracranial large arteries are involved to varying degrees, leading to different clinical phenotypes 8,9. Isolated cranial or extracranial GCA, which are at either end of this continuum, are relatively uncommon 10. Predominant cranial GCA is characterized by headache, jaw claudication and visual manifestations (representing the prototypical clinical picture of temporal arteritis). By contrast, predominant large-vessel GCA is characterized by more pronounced systemic manifestations, PMR, vascular bruits, limb claudication and imaging signs of inflammation in the aorta and its major branches 10. In some of these patients, vascular stenoses or aneurysms in association with other GCA features are the presenting clinical manifestations 9,11. PMR is characterized by pain and stiffness in the shoulder and pelvic girdles, which can have an abrupt or a subtle onset 3. Up to 20% of patients with PMR can present with a normal erythrocyte sedimentation rate (ESR) 12 , although the presence of both normal ESR and C-reactive protein (CRP) levels is rare 13-15. Glucocorticoids are the cornerstone of treatment for GCA and PMR. They are effective, but glucocorticoidrelated adverse effects occur in up to 85% of patients with GCA and 65% of patients with PMR, respectively 16-22. The IL-6 receptor inhibitor tocilizumab has become available as a glucocorticoid-sparing strategy in patients with GCA 23,24 , an approach that is also being evaluated for PMR 25,26. Management of both GCA and PMR is hampered by the lack of universally accepted definitions of remission and other disease states (such as low disease activity or vessel damage without active disease). Many questions about monitoring and long-term management are still unanswered (Box 1).

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“…Allerdings identifizierte eine Meta-Analyse von 8 Studien lediglich die Dauer der Corticoid-Therapie als prädiktiv für die Rezidivrate, mit höheren Rezidivzahlen bei kürzerer Behandlung. In dieser Analyse waren die Initialdosis, das Geschlecht oder das Alter ohne Einfluss [63].…”

Section: Rezidiveunclassified

Riesenzellarteriitis: Aktuelle Erkenntnisse zu Epidemiologie, Pathogenese, Diagnostik und Therapie

Keyßer

2019

Akt Rheumatol

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ZusammenfassungAls Riesenzellarteriitis (RZA, englisch giant cell arteritis, GCA) bezeichnet man eine Vaskulitis der großen Gefäße, also der Aorta sowie der aortennahen Gefäße erster und zweiter Ordnung. RZA sind in Manifestation und Verlauf vielgestaltige Erkrankungen, die häufig hohe Ansprüche an die Diagnostik und die langfristige Betreuung der Patienten stellen. Fortschritte in Ultraschall-, MRT- und Positronen-Emissionstomografie haben die Diagnostik erleichtert und den Blick für seltenere und ungewöhnliche Manifestationsformen geschärft, die früher oft unerkannt geblieben sind. Therapie der ersten Wahl sind auch heute noch Corticoide. Deren langfristige und hochdosierte Anwendung ist bei den meist älteren und oft polymorbiden Patienten nicht unproblematisch. MTX stellt eine sinnvolle Möglichkeit zur Corticoid-Einsparung dar. Die Einführung der Therapie mit Interleukin-6-Rezeptor-Antikörpern hat neue therapeutische Möglichkeiten für Patienten eröffnet, bei denen langfristige Steroidgaben gefährlich oder kontraindiziert sind. Hauptziel der Behandlung ist die Vermeidung von Komplikationen wie Erblindung, Gefäßverschlüssen oder Aneurysmata sowie die Verhinderung von Therapiekomplikationen.

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Prevalence of Giant Cell Arteritis Relapse in Patients Treated With Glucocorticoids: A Meta‐Analysis

Cited by 77 publications

References 56 publications

Treatment strategy introducing immunosuppressive drugs with glucocorticoids ab initio or very early in giant cell arteritis: A multicenter retrospective controlled study

Treatment strategy introducing immunosuppressive drugs with glucocorticoids ab initio or very early in giant cell arteritis: A multicenter retrospective controlled study

Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica

Riesenzellarteriitis: Aktuelle Erkenntnisse zu Epidemiologie, Pathogenese, Diagnostik und Therapie

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