Giant Cell Arteritis Outcomes in Canada Save
A retrospective cohort study of patients with giant cell arteritis (GCA) demonstrates relapses are common and seen in nearly half of patients, were common after treatment is stopped and is not effectively averted by methotrexate (MTX).
There have been several, recent, significant advances in the management of GCA. this retrospective cohort study evaluated treatment patterns, clinical outcomes, and GC burden in from a specialized clinic in Montreal, Canada (2017 to 2025) Treatments of interest included MTX, glucocorticoids (GCs) and tocilizumab (TCZ) and other immunosuppressives (OIS).
Among a total of 121 GCA patients, 69% achieved sustained remission, with similar rates in GC only and GC + TCZ ( 70%) groups, but lower in the GC + OIS group (40%).
Most patients remained on GCs after 1 year, highlighting the difficulty of achieving steroid-free remission.
Relapses occurred in nearly half of patients (48%). The median median time to relapse was 283.5 days.
- Methotrexate showed limited GC-sparing efficacy in 6 patients (60%).
- TCZ-patients had the lowest cumulative GC exposure (mean 3431 mg (vs. GC only -4690 mg)
- With TCZ discontinuation, 25% relapsed
Adverse events were generally low, but there were two bowel perforations in the TCZ group
In this study, relapses (common when treatment was stopped) were often due to reimbursement limits rather than disease activity.
In Canada, the current 1-year TCZ treatment limit may be inadequate for long-term disease control. The authors called for more steroid-sparing options, patient-centered management, and allowance for flexible long-term therapy.
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The author has no conflicts of interest to disclose related to this subject
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