TOPLINE

In a real-world cohort of patients with giant cell arteritis (GCA), a substantial proportion required glucocorticoid (GC) therapy for more than 2 years; a prior diagnosis of polymyalgia rheumatica (PMR) or GCA was associated with continuous GC treatment.

METHODOLOGY

• Researchers conducted a retrospective cohort study of 172 patients diagnosed with GCA at a fast-track clinic in Copenhagen, Denmark, between 2018 and 2020.
• A total of 172 patients were included, with a mean age of 75.0 years; 62.8% were female, and 26% had a previous diagnosis of PMR or GCA.
• Patients were followed from the fast-track clinic visit until December 2023, or death, with a median follow-up of 40.6 months.
• The primary endpoint was the cumulative incidence of GC discontinuation at 1, 2, 3, 4, and 5 years following the fast-track clinic visit, with death treated as a competing event.
• Secondary endpoints included identification of distinct clinical and laboratory-based phenotypes and their association with GC discontinuation and time to first relapse.

TAKEAWAY

• The cumulative incidence of GC discontinuation was 10% at 1 year, 43% at 2 years, and 58% at 3 years after the first-track clinic visit.
• For patients with new-onset GCA at the time of visit, the cumulative incidence of GC discontinuation was 11% at 1 year, 48% at 2 years, and 65% at 3 years after the visit, which was significantly higher than for patients with a previously established diagnosis of PMR or GCA (P = .03).
• A previous diagnosis of PMR or GCA was independently associated with a lower probability of GC discontinuation (subdistribution hazard ratio [HR], 0.54; P = .04), even after adjusting for multiple confounders.
• Four symptom-based phenotypes (visual disturbances, constitutional symptoms, headache, and PMR symptoms) and 3 laboratory-based phenotypes (low, moderate, and high inflammatory profiles) were identified, but neither was predictive of GC discontinuation or time to first relapse.

IN PRACTICE

"Despite rapid diagnosis and a strict GC tapering regimen in accordance with updated national and international guidelines, a substantial proportion of patients with GCA have a chronic, GC-dependent disease course," the authors wrote.

SOURCE

The study was led by Tanja Fromberg Gorlen, Copenhagen University Hospital - Rigshospitalet in Copenhagen, Denmark. It was published online on August 17 in Therapeutic Advances in Musculoskeletal Disease.

LIMITATIONS

The study relied on medical record documentation, leading to missing data and inconsistent recording of some variables. The cohort size may be in the lower range for cluster analyses, and the number of patients at risk decreased markedly after 3 years of follow-up, limiting the reliability of estimates beyond that point.

DISCLOSURES

The study was supported by grants from the Danish Rheumatism Association, Beckett-Foundation, and Direktør Michael Hermann Nielsens Mindelegat, afd. B. Some of the authors reported receiving research grants, speaker fees, and consultancy fees from various pharmaceutical companies.

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