Steroid-Sparing Agents and Patients With LV-GCA
A recent retrospective study showed that introducing steroid-sparing agents earlier in treatment may have a positive impact among patients with large-vessel giant cell arteritis (LV-GCA.)
Researchers studied patients who underwent total-body imaging of large vessels within 10 days of beginning steroid therapy for GCA. Those who were found to have large-vessel involvement were classified as LV-GCA; those without such large vessel involvement were classified as cranial-GCA (C-GCA). “Presenting features, treatments, and outcomes of LV-GCA and cranial-limited (C-GCA) patients were compared,” the authors reported.
The 161 patients with LV-GCA included in the study were younger than those with C-GCA, and had a longer diagnostic delay. Patients with C-GCA had increased incidence of headache and ischemic optic neuropathy, while patients with LV-GCA presented with increased systemic symptoms such as fever, weight loss, fatigue, night sweats, and dry cough.
“Corrected cumulative prednisone dose, relapse-free survival, relapse rate, and incidence of ascending aortic aneurysms were not significantly different between the two subgroups,” the authors wrote. “A steroid-sparing agent was added in 73% of LV- and 55.7% of C-GCA patients, but was introduced more frequently at baseline in LV-GCA patients (52% vs 23.5%). LV-GCA patients initially treated with glucocorticoid monotherapy relapsed sooner, and had a higher relapse rate.”
Tomelleri A, Campochiaro C, Sartorelli S, Farina N, Baldissera E, Dagna L. Presenting features and outcomes of cranial-limited and large-vessel giant cell arteritis: a retrospective cohort study Scand J Rheumatol Published online April 29, 2021.