Treatment strategy introducing immunosuppressive drugs with glucocorticoids ab initio or very early in giant cell arteritis: A multicenter retrospective controlled study
| Autor: | L. Gigante, Antonio Tavoni, S. L. Bosello, Daniele Cammelli, Gianfranco Vitiello, Francesca Angelotti, Elisa Gremese, Miriam Isola, Elena Treppo, Elena Cavallaro, Riccardo Capecchi, Dario Bruno, Luca Quartuccio, Salvatore De Vita |
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| Rok vydání: | 2020 |
| Předmět: |
lcsh:Immunologic diseases. Allergy
medicine.medical_specialty Settore MED/16 - REUMATOLOGIA Research paper Cyclophosphamide Immunology Gastroenterology Adverse events Giant cell arteritis Glucocorticoids Methotrexate Temporal arteritis Tocilizumab Treatment chemistry.chemical_compound Internal medicine Diabetes mellitus medicine Clinical endpoint Immunology and Allergy Adverse effect business.industry Incidence (epidemiology) medicine.disease chemistry lcsh:RC581-607 business medicine.drug |
| Zdroj: | Journal of Translational Autoimmunity Journal of Translational Autoimmunity, Vol 3, Iss, Pp 100072-(2020) |
| ISSN: | 2589-9090 |
| Popis: | Objective Glucocorticoids (GC) are associated with side effects in giant cell arteritis (GCA). Immunosuppressive therapies (ITs) have given conflicting results in GCA, regarding GC sparing effect. Primary endpoint is to evaluate whether very early introduction of ITs in GCA minimize the rate of GC-induced adverse events, in terms of infections, new onset systemic arterial hypertension, GC-induced diabetes and osteoporotic fractures. Methods A multicenter retrospective case-control study included 165 patients. One group included 114 patients who were treated with at least one IT given at diagnosis or within 3 months from the start of GC. A second group included 51 GCA who received only GC or an IT more than 3 months later. Results The most frequently used ITs were: methotrexate (138 patients), cyclophosphamide (48 patients) and tocilizumab (27 patients). No difference was observed as concerns the follow-up time between groups [48.5 (IQR 26–72) vs 40 (IQR 24–69), p = 0.3)]. The first group showed a significantly lower incidence of steroid-induced diabetes (8/114, 7% vs 12/51, 23.5%; p = 0.003) and no differences for the rate of infections (p = 0.64). The group was also exposed to lower doses of GC at first (p Highlights • Giant cell arteritis is still a glucocorticoid-dependent disease. • Very early introduction of immunosuppressive agents minimizes the use of glucocorticoids. • Incidence of diabetes could be decreased by this strategy. • Safety in the elderly seems to be guaranteed. |
| Databáze: | OpenAIRE |
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