Sustained Drug-Free Remission in Giant Cell Arteritis.

Fecha de publicación: 26/11/2024

Autores de IIS La Fe

• Francisco Miguel Ortiz Sanjuán

  Autor

Participantes ajenos a IIS La Fe

• Narvaez, Javier
• Dominguez, Marta
• Agirregoikoa, Eva Galindez
• Mendizabal, Javier
• Abasolo, Lydia
• Lluch, Judith
• Loricera, Javier
• Garrido, Noemi
• Castaneda, Santos
• Alvarado, Patricia Moya
• Larena, Carmen
• Estrada, Paula
• Galisteo, Carlos
• Riveros Frutos, Anne
• Salman, Tarek
• Vasques Rocha, Margarida
• Iniguez, Carlota L
• Gonzalez, Maria Garcia
• Blanco, Ricardo
• ARTESER Project Collaborative Group

Grupos

• Reumatología

  

  Leader

  José Andrés Román Ivorra

Abstract

OBJETIVE: To evaluate the frequency and timing of sustained drug-free remission (SDFR) in patients with giant cell arteritis (GCA) and to identify potential predictive factors of this outcome. METHODS: Retrospective review of all patients included in the large Spanish multicentre registry for GCA (ARTESER) with at least two years of follow-up. SDFR was defined as the absence of typical signs, symptoms, or other features of active GCA for =12 months after discontinuation of treatment. RESULTS: We included 872 patients. Forty-seven percent had received concomitant treatment with tocilizumab and/or immunosuppressants, mainly methotrexate.SDFR was achieved in 21.2% (185/872) of the patients. The cumulative rates of patients achieving SDFR at 2, 3, and 4 years were 6.3%, 20.5%, and 25.3%, respectively.Patients who achieved SDFR could reduce their prednisone dosage to 10mg/day (p=0.090) and 5mg/day (p=0.002) more quickly than those who did not. Relapses were less frequent in patients with SDFR (p=0.006).The presence of relapses (incident rate ratio: 0.492, p<0.001) and the need for intravenous methylprednisolone boluses at diagnosis (IRR: 0.575, p=0.003) were significantly associated with a decreased likelihood of achieving SDFR.Only 5 patients (2.7%) experienced a recurrence, with a median onset of 19 months after achieving SDFR (IQR 25th-75th: 14-35 months). CONCLUSION: Within 3-4 years of diagnosis, only one-quarter of patients with GCA successfully reached the SDFR. Once the SDFR was achieved, the likelihood of experiencing recurrence was low. Relapses and the need for glucocorticoid boluses appear to be predictors of long-term GC need.