Evolution of the Therapeutic Management of Giant Cell Arteritis: Analysis of Real-Life Practices over Two Timeframes (2014-2017 and 2018-2020)

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Nov 25

PMID 38002716

Authors

Hubert de Boysson

Anael Dumont

Paul Castan

Sophie Gallou

Jonathan Boutemy

Gwenola Maigne

Nicolas Martin Silva

Alexandre Nguyen

Samuel Deshayes

Achille Aouba

Affiliations

Soon will be listed here.

Abstract

To determine how therapeutic strategies for giant cell arteritis (GCA), especially glucocorticoid (GC) management, evolved between 2014 and 2020. Consecutive GCA patients followed for at least 24 months in a single tertiary center were enrolled and separated into two groups: those diagnosed from 2014 to 2017 and those diagnosed from 2018 to 2020. GC doses (mg/kg/day) were analyzed at onset, at Month 3 (M3) and, if continued, at M6, M12, M18 and M24. Physicians' practices were also individually analyzed. Among the 180 patients included, 96 (53%) were diagnosed in 2014-2017 and 84 (47%) in 2018-2020. All patients received GC at diagnosis without a difference in the initial dose between the two groups ( = 0.07). At M3, the daily dose was lower in patients treated after 2017 ( = 0.002). In patients who still received GC at M6 ( = 0.0008), M12 ( = 0.01) and M24 ( = 0.02), the daily GC dose was still lower in patients treated after 2017. The proportion of patients who definitively discontinued GC use before M18 (42% versus 21%, = 0.003) was higher in those treated after 2017. The rates of immunosuppressant use were not different between the two time periods (31% versus 38%, = 0.34), but tocilizumab replaced methotrexate. Significant differences were observed among practitioners regarding the GC doses at M6 ( = 0.04) and M12 ( = 0.04), the total GC duration ( = 0.02) and the ability to stop GC before M18 ( = 0.007). This real-life study showed a global change in GC management over time for GCA patients, with important variability among physicians' practices.

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