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Perez-Sancristobal I, Alvarez-Hernandez P, Lajas-Petisco C, Fernandez-Gutierrez B. Effect of combined treatment with prednisone and methotrexate versus prednisone alone over laboratory parameters in giant cell arteritis. REUMATOLOGIA CLINICA 2024; 20:108-112. [PMID: 38395494 DOI: 10.1016/j.reumae.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/21/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To compare the effect of combined treatment with prednisone and methotrexate (MTX) versus prednisone alone over laboratory parameters in giant cell arteritis (GCA). PATIENTS AND METHODS We performed a double-blind, placebo-controlled, randomized clinical trial about usefulness of treatment with prednisone and MTX versus prednisone and placebo in GCA (Ann Intern Med 2001;134:106-114). As a part of follow-up of patients (n=42), we performed laboratory analysis in 20 time points during the two-year period of follow-up. To analyze differences, we calculated the area under the curve (AUC) for erythrocyte sedimentation rate (ESR), hemoglobin, and platelets, and compared the results in both groups adjusting by time of follow-up, existence of relapses and dose of prednisone. RESULTS A total of 724 laboratory measurements were done. Median value of ESR was 33 [18-56] in patients with placebo and 26 [15-44] in patients with MTX (P=0.0002). No significant differences were observed in ESR during relapses. The mean ESR value followed a parallel course in both groups, but was lower in the group with MTX than in the group with placebo in 18 of 20 time points of follow-up. The AUC of ESR by time of follow-up was 28,461.7±12,326 in the group with placebo and 19,598.4±8,117 in the group with MTX (mean difference 8,863, 95% CI 1.542-16.184; P=0.019). The course of other laboratory parameters paralleled, without statistical significance, those observed for ESR. CONCLUSIONS These data, along with clinical data, suggest that MTX might play a role as a disease-modifying agent in the treatment of GCA.
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Affiliation(s)
| | | | - Cristina Lajas-Petisco
- UGC Reumatologia, Hospital Clinico San Carlos, IdISSC, Madrid, Spain; Universidad Complutense de Madrid. Spain
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Quick V, Abusalameh M, Ahmed S, Alkoky H, Bukhari M, Carter S, Coath FL, Davidson B, Doddamani P, Dubey S, Ducker G, Griffiths B, Gullick N, Heaney J, Holloway A, Htut EEP, Hughes M, Irvine H, Kinder A, Kurshid A, Lim J, Ludwig DR, Malik M, Mercer L, Mulhearn B, Nair JR, Patel R, Robson J, Saha P, Tansley S, Mackie SL. Relapse after cessation of weekly tocilizumab for giant cell arteritis: a multicentre service evaluation in England. Rheumatology (Oxford) 2023:kead604. [PMID: 37952183 DOI: 10.1093/rheumatology/kead604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/15/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVES The National Health Service in England funds 12 months of weekly subcutaneous tocilizumab (qwTCZ) for patients with relapsing or refractory giant cell arteritis (GCA). During the COVID-19 pandemic, some patients were allowed longer treatment. We sought to describe what happened to patients after cessation of qwTCZ. METHODS Multicentre service evaluation of relapse after stopping qwTCZ for GCA. The log-rank test was used to identify significant differences in time to relapse. RESULTS 336 GCA patients were analysed from 40 centres, treated with qwTCZ for a median (interquartile range, IQR) of 12 (12-17) months. At time of stopping qwTCZ, median (IQR) prednisolone dose was 2 (0-5) mg/day. By 6, 12 and 24 months after stopping qwTCZ, 21.4%, 35.4% and 48.6% respectively had relapsed, requiring an increase in prednisolone dose to a median (IQR) of 20 (10-40) mg/day. 33.6% of relapsers had a major relapse as defined by EULAR. Time to relapse was shorter in those that had previously also relapsed during qwTCZ treatment (P = 0.0017); in those not in remission at qwTCZ cessation (P = 0.0036); and in those with large vessel involvement on imaging (P = 0.0296). Age ≥65, gender, GCA-related sight loss, qwTCZ treatment duration, TCZ taper, prednisolone dosing, and conventional synthetic DMARD use were not associated with time to relapse. CONCLUSION Up to half our patients with GCA relapsed after stopping qwTCZ, often requiring a substantial increase in prednisolone dose. One third of relapsers had a major relapse. Extended use of TCZ or repeat treatment for relapse should be considered for these patients.
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Affiliation(s)
- Vanessa Quick
- Rheumatology Department, Luton, Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UKand
| | - Mahdi Abusalameh
- Rheumatology Department, Royal Devon University Healthcare NHS Foundation Trust, Devon, UK
| | - Sajeel Ahmed
- Rheumatology Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Hoda Alkoky
- Rheumatology Department, Luton, Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UKand
| | - Marwan Bukhari
- Lancaster University, Lancaster, UK
- Rheumatology Department, Royal Lancaster Infirmary, Lancaster, UK
| | - Stuart Carter
- Rheumatology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Fiona L Coath
- Rheumatology Department, Southend University Hospital NHS Trust, Southend, UK
| | - Brian Davidson
- Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Parveen Doddamani
- Rheumatology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Shirish Dubey
- Department of Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Dept of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Georgina Ducker
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Bridget Griffiths
- Rheumatology Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Nicola Gullick
- Rheumatology Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Rheumatology Department, Coventry & Warwick Medical School, University of Warwick, Warwick, UK
| | - Jonathan Heaney
- Rheumatology Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Amelia Holloway
- Rheumatology Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - Ei Ei Phyu Htut
- Department of Rheumatology, Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Mark Hughes
- Rheumatology Department, Royal Cornwall Hospitals NHS Trust, Cornwall, UK
| | - Hannah Irvine
- Department of Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alison Kinder
- Rheumatology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Asim Kurshid
- Rheumatology Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Joyce Lim
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Dalia R Ludwig
- Rheumatology Department University College London NHS Foundation Trust, London, UK
| | - Mariam Malik
- Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Louise Mercer
- Rheumatology Department, Stockport NHS Foundation Trust, Stockport, UK
| | - Ben Mulhearn
- Department of Life Sciences, University of Bath, Bath, UK
- Royal United Hospital for Rheumatic Diseases, Royal United Hospitals Bath, Bath, UK
| | - Jagdish R Nair
- Rheumatology Department, Liverpool University Hospitals (Aintree), Liverpool, UK
- The National Behcet's Centre of Excellence, Liverpool, UK
| | - Rikesh Patel
- Rheumatology Department, Manchester University Foundation NHS Trust, Manchester Royal Infirmary, Manchester, UK
| | - Joanna Robson
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
- Department of Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Pratyasha Saha
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Sarah Tansley
- Department of Life Sciences, University of Bath, Bath, UK
- Royal United Hospital for Rheumatic Diseases, Royal United Hospitals Bath, Bath, UK
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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