TOPLINE

Despite reduced high-dose use, patients with giant cell arteritis (GCA) diagnosed in 2022 still had substantial glucocorticoid (GC) exposure and greater use of GC-sparing agents. Each gram of cumulative GC exposure was associated with higher mortality, and even doses as low as ≤ 5 mg/d were linked to serious infections and major adverse cardiovascular events (MACE).

METHODOLOGY

• Researchers conducted a retrospective, population-based cohort study using the French national health insurance database, which covers nearly the entire French population.
• A total of 18,301 patients with incident GCA diagnosed between January 2010 and December 2022 were included; mean age was 75.2 years, and 63% were female.
• Latent class growth modeling identified four distinct GC use trajectories over the 2 years following diagnosis: medium-dose quick taper (51.3%), low-dose quick taper (33.6%), high-dose quick taper (HDQT, 10.3%), and high-dose slow taper (HDST, 4.8%).
• Multivariable survival models evaluated associations between cumulative GC exposure and mortality, serious infections, MACE, and osteoporotic fractures.
• Mean follow-up duration was 6.7 years, and the study captured all reimbursed GC prescriptions dispensed through local pharmacies as well as in-hospital tocilizumab infusions.

TAKEAWAY

• The average 2-year cumulative GC dose remained high despite a modest decrease from 9.4 g in patients diagnosed in 2010 to 7.6 g in those diagnosed in 2022; the proportion of patients in high-dose trajectories HDQT and HDST declined from 9.8% and 8.1% to 7.3% and 1.6%, respectively.
• While cumulative methotrexate use remained relatively stable since 2020, tocilizumab prescribing increased sharply, with over 25% of patients diagnosed in 2022 receiving tocilizumab by end of follow-up.
• Each gram of cumulative GC exposure was associated with increased all-cause mortality (hazard ratio [HR], 1.024; 95% CI, 1.021-1.027), serious infection (HR, 1.050; 95% CI, 1.038-1.062), MACE (HR, 1.015; 95% CI, 1.010-1.020), and major osteoporotic fractures (HR, 1.013; 95% CI, 1.006-1.019).
• Cumulative exposure to GC doses ≤ 5 mg/d was associated with increased risk for serious infection (HR, 1.13; 95% CI, 1.00-1.29) and MACE (HR, 1.04; 95% CI, 1.01-1.08), indicating that even low-dose GC exposure is not safe.

IN PRACTICE

"Our findings highlight that the burden associated with cumulative GC exposure remains important, and that even low GC doses do not appear to be safe. Overall, our work under scores the need for continuous and accelerated efforts to reduce GC use in GCA," wrote the authors of the study.

SOURCE

The study was led by Maxime Beydon, Sorbonne Université, INSERM, Institut Sorbonne de Santé Publique, Equipe PEPITES, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi) in Paris, France. It was published online on July 7, 2026, in RMD Open.

LIMITATIONS

The study lacked access to medical records, precluding assessment of clinical or biological variables such as disease activity, which was approximated using proxies including initiation of steroid-sparing agents, C-reactive protein measurements, and hospitalizations for GCA. In-hospital GC prescriptions, including methylprednisolone pulses, were unavailable, potentially underestimating cumulative GC exposure. 

DISCLOSURES

The study was supported by grants from the National Institute of Health and Medical Research (INSERM) and Assistance Publique des Hôpitaux de Paris (CRC). Multiple authors reported receiving consulting fees, honoraria, or research support from various pharmaceutical companies. One author is Head of the the Centre de Pharmacoépidémiologie (Cephepi) of Assistance Publique – Hôpitaux de Paris and of the Clinical Research Unit of Pitié-Salpêtrière Hospital.

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