Full Papers
Giant cell arteritis in clinical practice: beyond GiACTA
F. Regola1, J. Mora2, M. Riva3, G. Fontana4, A. Gatti5, I. Cavazzana6, F. Franceschini7, P. Toniati8
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia; and Department of Clinical and Experimental Sciences, University of Brescia, Italy. f.regola@unibs.it
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia; and Department of Clinical and Experimental Sciences, University of Brescia, Italy.
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy.
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia; and Department of Clinical and Experimental Sciences, University of Brescia, Italy.
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia; and Department of Clinical and Experimental Sciences, University of Brescia, Italy.
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia; and Department of Clinical and Experimental Sciences, University of Brescia, Italy.
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia; and Department of Clinical and Experimental Sciences, University of Brescia, Italy.
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Italy.
CER19004
Full Papers
PMID: 41328604 [PubMed]
Received: 11/06/2025
Accepted : 29/09/2025
In Press: 13/11/2025
Abstract
OBJECTIVES:
Giant cell arteritis (GCA) therapy relies on high-dose glucocorticoids (GCs), which are associated with a high incidence of side effects and GCA relapses, highlighting the need for steroid-sparing agents such as tocilizumab (TCZ) and methotrexate (MTX). The aims of this study were to analyse GC side effects and to assess the steroid-sparing efficacy of TCZ and MTX in a real-life cohort of patients with GCA through the application of the Glucocorticoid Toxicity Index (GTI) version 2.0.
METHODS:
This retrospective cohort study included patients with a new diagnosis of GCA made in our Centre and classified according to therapy, respectively GCs alone, GCs plus MTX, and GCs plus TCZ. GTI was calculated over a 5-year follow-up period.
RESULTS:
We enrolled 150 patients, with a median follow-up of 21 (11-39) months. During this period, 88% experienced at least one GC side effect. The cumulative GC dose was an independent predictor of the GTI-cumulative worsening score (CWS), regardless of treatment group or follow-up time. As first-line therapy, TCZ reduced GC dose by 25% compared to GCs alone, leading to fewer side effects (65% vs. 90%), less GC-induced damage, and no GCA relapses (0% vs. 38%). TCZ also independently protected against relapses, regardless of GC dose or follow-up time. In contrast, MTX did not show similar benefits in any aspect.
CONCLUSIONS:
GCs represent a cornerstone in GCA therapy, but their cumulative dose correlates with induced damage, as quantified by the GTI. TCZ demonstrated steroid-sparing effect and clinical efficacy in a large real-life cohort.
