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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.