TOPLINE:

An alternative regimen of intravenous methylprednisolone plus methotrexate with lower-dose oral prednisone was as effective in treating giant cell arteritis as the standard-of-care regimen of high-dose oral prednisone, with reduced glucocorticoid exposure and fewer related complications.

METHODOLOGY:

• An observational study was conducted across three Spanish hospitals to compare two glucocorticoid regimens in treating 151 patients newly diagnosed with giant cell arteritis (mean age, 74.6 years; 71% women).
• Among them, 79 patients received the standard-of-care regimen of 40-60 mg/d oral prednisone (or equivalent) for 4 weeks, which was then tapered to 5 to 2.5 mg/d; 72 patients received an alternative regimen of three pulses of intravenous methylprednisolone (125-500 mg/d), followed by lower-dose prednisone (at a starting dose of 20-30 mg/d) on a tapering schedule, plus methotrexate.
• The main outcomes were remission — defined as no clinical signs or symptoms of the disease with an erythrocyte sedimentation rate (ESR) less than 30 mm/h and a C-reactive protein (CRP) level less than 10 mg/L — and relapse — defined as symptom recurrence with a rise in CRP level or ESR.
• Baseline differences between the two groups were adjusted using propensity scores, and patients were followed up for a period of 2 years.

TAKEAWAY:

• All patients achieved remission after a median duration of 4 weeks, with no significant differences between the treatment groups in terms of time to remission or the risk for relapse.
• Patients on the alternative regimen tapered to a prednisone dose of ≤ 5 mg/d faster than those on the standard-of-care regimen (mean time, 13.9 vs 56.6 weeks; P < .001) and received a lower cumulative dose of prednisone (P < .001).
• Fewer patients on the alternative regimen experienced glucocorticoid-related complications than those on the standard-of-care regimen (20% vs 37%; P = .019).

IN PRACTICE:

“Although these results should be prospectively assessed in clinical trials and larger cohorts of patients with GCA [giant cell arteritis], the initial treatment with high doses of IVMP [intravenous methylprednisolone] during 3 days followed by reduced doses of prednisone plus MTX [methotrexate] could be a reasonable GC [glucocorticoid]-sparing therapeutic strategy for remission induction and maintenance in patients with GCA, especially those at higher risk for GC toxicity,” the authors of the study wrote. 

SOURCE:

This study was led by Adriana Soto-Peleteiro, Hospital Universitario de Cruces, Bizkaia, and José Hernández-Rodríguez, University of Barcelona, Barcelona, both in Spain. It was published online on September 16, 2025, in Rheumatology.

LIMITATIONS:

Drug dosages varied across the treatment protocols. The small number of patients made it difficult to assess efficacy and toxicity of different doses of intravenous methylprednisolone. The follow-up period was relatively short.

DISCLOSURES:

One author reported receiving support from the Department of Education of the Basque Government. Another author reported receiving research grants from Consejeria de Transformación Económica, Industria, Conocimiento y Universidades, and Junta de Andalucia-Sevilla. The other authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.