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Effectiveness and safety of medium-dose prednisone in giant cell arteritis: a retrospective cohort study of 103 patients

1, 2, 3, 4, 5

 

  1. Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, Bizkaia, Spain.
  2. Clinical Epidemiology Unit, BioCruces Health Research Institute, Hospital Universitario Cruces, Bizkaia, and 4Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Spain.
  3. Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, Bizkaia, Spain.
  4. Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, Bizkaia, and University of the Basque Country, Bizkaia, Spain.
  5. Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, Bizkaia, and University of the Basque Country, Bizkaia, Spain.

CER8125
2015 Vol.33, N°2 ,Suppl.89
PI 0090, PF 0097
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PMID: 26016756 [PubMed]

Received: 15/11/2014
Accepted : 17/02/2015
In Press: 26/05/2015
Published: 26/05/2015

Abstract

OBJECTIVES:
To compare the effectiveness and safety of medium-dose (MD) and high-dose (HD) prednisone regimens and to identify factors related to remission with a target maintenance dose of prednisone in patients with giant cell arteritis (GCA).
METHODS:
Retrospective cohort study conducted in an autoimmune diseases unit. Patients received ≤30 mg (MD group) or >30 mg (HD group) of daily prednisone as monotherapy or combined with methylprednisolone pulses and/or methotrexate, at the discretion of the physician. The primary endpoint was time to clinical and biological remission receiving a prednisone maintenance dose ≤7.5 mg/day. Factors related to the primary endpoint were identified by Cox regression analysis.
RESULTS:
Overall, 103 patients (MD=53, HD=50) were followed for a median (95%CI) of 2.85 (2.57-3.52) years. Both groups exhibited similar baseline features except for ocular ischaemic manifestations (MD=21%, HD=48%, p=0.004). Patients in the MD group had a shorter time to the primary endpoint (MD=186 [147-223], HD=236 [177-276] days, HR=1.70 [1.12-2.57], p=0.01) with no increase in relapses (MD=39%, HD=50%, p=0.29) or GCA complications (MD=11%, HD=16%, p=0.49). Cumulative prednisone doses at 6 months were 2.47±0.70 g for MD patients and 3.86±1.85 g for HD patients (p<0.001). Adverse effects were more frequent among HD recipients (MD=43%, HD=66%, p=0.02). The only independent factor associated with the primary endpoint was the use of methylprednisolone pulses (HR=2.21 [1.31-3.71], p=0.003).
CONCLUSIONS:
MD prednisone regimen may be an effective and safe alternative to HD prednisone regimen in GCA. Induction with methylprednisolone pulses predicts a better response, allowing for a less intensive prednisone regimen.

Rheumatology Article