Are emulation ‘trials’ helpful, despite the biases that occur with observational data, or do they truly mimic the results of randomized controlled trials (RCTs)?

Clinicians treating giant cell arteritis (GCA) have long had to contend with a disappointingly limited selection of drugs from which to select. A new group of drugs is finally showing promise in the treatment of GCA.

For many years glucocorticoids were the mainstay of our treatment of granulomatosis with polyangiitis (GPA). The paradigm shifted with cyclophosphamide and then again with rituximab, and we used less steroids, but we still used lots. Avacopan teased the demise of steroids, but in the trial they, and now we, still use them. Glucocorticoids are our old trusty friend, our comfort blanket. But no more! Good riddance to the medication with the highest long-term adverse event burden that we use. Long-term glucocorticoids in GPA should now be a rarity. The reason for such exuberance is the TAPIR study presented by Dr. Peter Merkel at Saturday’s opening plenary session.