Tuesday, 15 Oct 2019

You are here

GCA Relapse Risk High with Steroids

Prior to the introduction of tocilizumab to manage giant cell arteritis (GCA), glucocorticoids (GC) have been the mainstay of therapy, but has been limited by relapses in disease. A recent metanalysis shows that relapses occur in nearly half of patients and are related to the duration of therapy rather than the initial dose of GC.

A literature review found 34 studies (2,505 patients) from 8 RCTs of GCA patients only treated with GC.

The overall prevalence of relapse was 47.2%, higher in RCTS than observational studies (p<0.0001).

The relapse rate was higher in older studies, reflecting a reliance on GC to treat GCA.

Shorter GC regimens were also associated with higher relapse rates (17 studies, rate decrease of 1.7% for one additional month, p<0.001). The duration of GC therapy was shorter in RCTs (12.8 months) than observational studies (28.8 months).

Relapse was not affected by the duration of GC therapy, initial GC dose, duration of follow‐up, sex or age.

These results suggest that trial designs in GCA call for at least 12 months of GC therapy to adequately assess risk of relapse.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Warfarin Superior to Xarelto in Antiphospholipid Syndrome

A 3 year, multicenter, European, study shows that rivaroxaban was inferior to warfarin in preventing thrombosis in patients with antiphospholipid syndrome (APS) according to the Annals of Internal Medicine. Thus despite the inconvenience of warfarin, it remains the best option for patients with APS.

Declining Trends in Antineutrophil Cytoplasmic Autoantibody–Associated Vasculitis Mortality in the USA

Annals of Internal Medicine reports that age-adjusted mortality rates for antineutrophil cytoplasmic autoantibody–associated vasculitides (AAV) have improved over time - with a decline of nearly 2 percent per year in the United States from 1999 to 2017. Nevertheless, long-term outcomes continue to lag behind mortality rates of the general population.

Serum Interferon Predicts Lupus Flares

Elevated serum levels of interferon-α among patients whose systemic lupus erythematosus (SLE) was in remission helped predict future disease flares, European researchers found.

Among 254 SLE patients who were in remission, 26% had abnormally high serum levels of interferon-α at baseline, according to Alexis Mathian, MD, of Pitié-Salpêtrière Hospital in Paris, and colleagues.

ILD Patients At Risk for Autoimmune Disease

Patients diagnosed with interstitial pneumonia with autoimmune features (IPAF) are at an increased risk of developing a systemic autoimmune rheumatic disease (ARD).

A retrospective study of interstitial lung disease (ILD) patients from the Columbia University Irving Medical Center (2009 to 2017) looked for those who did or did not meet IPAF criteria.

MMWR: Increased Opioid Use in Lupus

Opioids are generally not indicated for pain in systemic lupus erythematosus (SLE) and other rheumatic diseases because of limited efficacy and risks for preference and adverse health effects.