Treatment of giant cell arteritis using induction therapy with high‐dose glucocorticoids: A double‐blind, placebo‐controlled, randomized prospective clinical trial

Abstract

Objective. Glucocorticoid (GC) therapy for giant cell arteritis (GCA) is effective but requires prolonged administration, resulting in adverse side effects. The goal of the current study was to test the hypothesis that induction treatment with high-dose pulse intravenous (IV) methylprednisolone permits a shorter course of therapy.Methods. Twenty-seven patients with biopsyproven GCA were enrolled in a randomized, doubleblind, placebo-controlled study to receive IV methylprednisolone (15 mg/kg of ideal body weight/day) or IV saline for 3 consecutive days. All patients were started on 40 mg/day prednisone and followed the same tapering schedule as long as disease activity was controlled. The numbers of patients with disease in remission after 36, 52, and 78 weeks of treatment and taking <5 mg/day prednisone were compared. Cumulative prednisone dose, number of relapses, and development of adverse GC effects were assessed.Results. Ten of the 14 IV GC-treated patients, but only 2 of 13 control patients, were taking <5 mg/day prednisone at 36 weeks (P ‫؍‬ 0.003). This difference was maintained; there was a higher number of sustained remissions after discontinuation of treatment in the IV GC-treated group and a lower median daily dose of prednisone at 78 weeks (P ‫؍‬ 0.0004). The median cumulative dose of oral prednisone, excluding the IV GC dose, was 5,636 mg in the IV GC-treated group compared with 7,860 mg in the IV saline-treated group (P ‫؍‬ 0.001).Conclusion. Initial treatment of GCA with IV GC pulses allowed for more rapid tapering of oral GCs and had long-term benefits, with a higher frequency of patients experiencing sustained remission of their disease after discontinuation of treatment.

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 ].…”

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

“…Initial therapy for active Takayasu arteritis and active giant cell arteritis should be corticosteroids at a high dose (prednisone 40 to 60 mg daily at initiation or its equivalent) to reduce the active inflammatory state. 66,67 (Level of Evidence: B) 2. The success of treatment of patients with Takayasu arteritis and giant cell arteritis should be periodically evaluated to determine disease activity by repeated physical examination and either an erythrocyte sedimentation rate or C-reactive protein level.…”

Giant cell (temporal) arteritis

“…metilprednizolon tedavisi konvansiyonel prednizolon 40 mg/gün tedavisi ile sa¤lamas› aç›-s›ndan karfl›laflt›r›lm›flt›r. [52] Çal›flmada, biyopsi ile kan›t-lanm›fl DHA tan›l› 27 hasta randomize i.v. metilprednizolon (15 mg/kg günde 3 doz) veya i.v.…”