Steroid Delusions in Giant Cell Arteritis Save

A real world analysis of drug use in giant cell arteritis (GCA) patients shows that despite intending to taper patients off glucocorticoids (GC) by 24 months, 75% remained on GCs for ≥ 48 months. 

Dua et al published the results of a rheumatologist/6 country (France, Germany, Italy, Spain, UK, USA) cross-sectional retrospective survey on GCA management. 

A total of 196 rheumatologists reported on 846 cases, of whom 221 (26.1%) patients self-reported their experiences. Among all 846 patients, 63% were female, with a mean age of 71 years and a median of 15.2 months since GCA diagnosis.  Nearly all (≥ 99%) received GCs within the last 12 months. 

Median steroid exposure in the last 12 mos (by time since diagnosis):

• GCA < 12 mos: 4343 mg
• GCA 12–24 mos: 5200 mg
• GCA dx > 24 months ago: 2196 mg

Most rheumatologists intended to stop GCs by 24 months. But: 

• 80% of patients receiving mean 8.4 mg/day between  24–36 months
• 75% receiving 5.3 mg/day at ≥ 48 months. 

Most rheumatologists (≥ 90%) believed advanced therapies should be given early in GCA. YET, only 48% reported prescribing an advanced therapy at any point after diagnosis. 

GC-related adverse events in elderly GCA patients underscores the need for less steroids and and effective steroid-sparing interventions.

Or at least realizing that we are not doing what we think we are doing...