Rapid Glucocorticoid Tapering Regimen in Patients with Giant Cell Arteritis: a Single Centre Cohort Study

Overview

Journal RMD Open

Publisher BMJ Publishing Group

Specialty Rheumatology

Date 2023 Jul 17

PMID 37460275

Authors

Noemi Mensch

Andrea Katharina Hemmig

Markus Aschwanden

Stephan Imfeld

Mihaela Stegert

Mike Recher

Daniel Staub

Diego Kyburz

Christoph T Berger

Thomas Daikeler

Affiliations

Soon will be listed here.

Abstract

Objectives: We evaluated the feasibility of a rapid glucocorticoid tapering regimen to reduce glucocorticoid exposure in patients with giant cell arteritis (GCA) treated with glucocorticoids only.

Methods: Newly diagnosed patients with GCA treated with a planned 26-week glucocorticoid tapering regimen at the University Hospital Basel were included. Data on relapses, cumulative steroid doses (CSD) and therapy-related adverse effects were collected from patients' records.

Results: Of 47 patients (64% women, median age 72 years), 32 patients (68%) had relapsed. Most relapses were minor (28/32) and 2/3 of those were isolated increased inflammatory markers (19/32). Among major relapses, one resulted in permanent vision loss. The median time until relapse was 99 days (IQR 71-127) and median glucocorticoid dose at relapse was 8 mg (IQR 5-16). Nine of 47 patients stopped glucocorticoids after a median duration of 35 weeks and did not relapse within 1 year. Median CSD at 12 months was 4164 mg which is lower compared with published data. Glucocorticoid-associated adverse effects occurred in 40% of patients, most frequently were new onset or worsening hypertension (19%), diabetes (11%) and severe infections (11%).

Conclusion: We could demonstrate that 32% of patients remained relapse-free and 19% off glucocorticoids at 1 year after treatment with a rapid glucocorticoid tapering regimen. Most relapses were minor and could be handled with temporarily increased glucocorticoid doses. Consequently, the CSD at 12 months was much lower than reported in published cohorts. Thus, further reducing treatment-associated damage in patients with GCA by decreasing CSD seems to be possible.

Citing Articles

Risk Factors and Pharmacological Interventions Impacting Cerebrovascular Ischemic Events in Giant Cell Arteritis: A Narrative Review.

Siddiqui M, Syed M, Qureshi A, Imam M, Motwani J, Kumari V Immun Inflamm Dis. 2025; 13(1):e70122.

PMID: 39817601 PMC: 11736630. DOI: 10.1002/iid3.70122.

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