Abstract
Objectives:
GCA patients with large vessel involvement (LV-GCA) experience greater steroid requirements and higher relapse rates, compared to classical cranial GCA. Despite the distinct disease course, interventions in LV-GCA have yet to be specifically investigated. This study aimed to evaluate the steroid sparing effect and tolerability of first-line mycophenolate in LV-GCA.
Methods:
A retrospective cohort study was conducted in patients with LV-GCA identified from a regional clinical database between 2005 and 2019. All cases were prescribed mycophenolate derivatives (mycophenolate mofetil or mycophenolic acid, MYC) at diagnosis and were followed up for at least 2 years. The primary outcome was cumulative steroid dose at 1 year. Secondary outcomes included MYC tolerance, relapse rates and CRP levels at 1 and 2 years.
Results:
A total of 37 patients (65% female; mean age 69.4, SD7.9) were identified. All cases demonstrated large vessel involvement via CT/PET n=34, CTA n=5 or MRA n=2. After 2 years, 31 patients remained on MYC, whilst 6 switched to methotrexate or tocilizumab due to significant disease relapse. The
mean cumulative prednisolone dose at 1 year was 4960 (±1621) mg. Relapse rates at 1 and 2 years were 16.2% and 27% respectively, whilst CRP levels at 1 and 2 years were 4 mg/L (IQR 4-6 mg/L) and 4 mg/L (IQR 4-4 mg/L) respectively.
Conclusion:
To our knowledge, this is the first effort to assess the effectiveness of any specific agent in LV-GCA. MYC may be both effective in reducing steroid exposure and well tolerated in this sub-population. A future randomised controlled trial is warranted.
GCA patients with large vessel involvement (LV-GCA) experience greater steroid requirements and higher relapse rates, compared to classical cranial GCA. Despite the distinct disease course, interventions in LV-GCA have yet to be specifically investigated. This study aimed to evaluate the steroid sparing effect and tolerability of first-line mycophenolate in LV-GCA.
Methods:
A retrospective cohort study was conducted in patients with LV-GCA identified from a regional clinical database between 2005 and 2019. All cases were prescribed mycophenolate derivatives (mycophenolate mofetil or mycophenolic acid, MYC) at diagnosis and were followed up for at least 2 years. The primary outcome was cumulative steroid dose at 1 year. Secondary outcomes included MYC tolerance, relapse rates and CRP levels at 1 and 2 years.
Results:
A total of 37 patients (65% female; mean age 69.4, SD7.9) were identified. All cases demonstrated large vessel involvement via CT/PET n=34, CTA n=5 or MRA n=2. After 2 years, 31 patients remained on MYC, whilst 6 switched to methotrexate or tocilizumab due to significant disease relapse. The
mean cumulative prednisolone dose at 1 year was 4960 (±1621) mg. Relapse rates at 1 and 2 years were 16.2% and 27% respectively, whilst CRP levels at 1 and 2 years were 4 mg/L (IQR 4-6 mg/L) and 4 mg/L (IQR 4-4 mg/L) respectively.
Conclusion:
To our knowledge, this is the first effort to assess the effectiveness of any specific agent in LV-GCA. MYC may be both effective in reducing steroid exposure and well tolerated in this sub-population. A future randomised controlled trial is warranted.
| Original language | English |
|---|---|
| Article number | rkaa069 |
| Journal | Rheumatology Advances in Practice |
| Volume | 4 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 19 Dec 2020 |
Bibliographical note
Funding: We are grateful to Versus Arthritis (grant 22088) and PMR/GCA Scotland for supporting our workKeywords
- Large vessel vasculitids
- giant cell arteritis
- mycophenolate
- steroid sparing
- relapse rate