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

Journal of Translational Autoimmunity

Miriam Isola¹  Riccardo Capecchi²  Gianfranco Vitiello²  Silvia Laura Bosello²  Dario Bruno³  Antonio Tavoni⁴  Luca Quartuccio⁴  Laura Gigante⁴  Elisa Gremese⁴  Daniele Cammelli⁵  Francesca Angelotti⁶  Elena Treppo⁶  Salvatore De Vita⁷  Elena Cavallaro⁷ 

[1] Corresponding author.;Department of Internal Medicine, Clinic of Immunology, Pisa, Italy;Department of Medicine, Institute of Statistics, University of Udine, Udine, Italy;Department of Medicine, Rheumatology Clinic, Udine Academic Hospital “Santa Maria Della Misericordia”, Udine, Italy;Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy;Rheumatology Unit, Catholic University of the Sacred Heart, Rome, Italy;University of Florence, Florence, Italy;

关键词: Giant cell arteritis;    Temporal arteritis;    Treatment;    Glucocorticoids;    Methotrexate;    Tocilizumab;   

DOI  :  

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown