TOPLINE:

In patients newly diagnosed with giant cell arteritis (GCA), the use of short intravenous (IV) pulses of methylprednisolone followed by the administration of a reduced dose of oral prednisone was associated with faster remission and lower overall exposure to steroids than the use of oral prednisone alone.

METHODOLOGY:

• Researchers conducted a retrospective study in a real-world observational cohort to assess whether IV methylprednisolone pulses followed by the administration of reduced-dose oral glucocorticoids were a safe and effective initial treatment for GCA.
• They included 206 patients newly diagnosed with GCA (mean age, 74.4 years; 61.2% women) from multiple centers across Madrid, Spain, between 2008 and 2025.
• Overall, 56.3% of patients received methylprednisolone pulses (median dose, 250 mg/d for a median of 3 days) followed by oral prednisone (median initial dose, 30 mg/d); 43.7% received oral prednisone alone (median initial dose, 50 mg/d).
• The primary outcome was time to remission, defined as the absence of clinical signs and symptoms of active GCA with normalization of acute-phase reactants, with follow‑up for the first 3 months after starting treatment.
• Secondary outcomes included a change in cumulative prednisone dose at remission, change in average daily prednisone dose until remission, remission at 3 months, and glucocorticoid-related adverse effects at 3 months.

TAKEAWAY:

• In an adjusted analysis, treatment with methylprednisolone pulses was associated with an average 14.2-week shorter time to remission than treatment with oral glucocorticoids alone (P < .001).
• Overall, 95.1% of patients achieved remission. Patients treated with methylprednisolone pulses were more likely to achieve remission than those treated with oral glucocorticoids alone (adjusted hazard ratio, 2.44; 95% CI, 1.66-3.59).
• Patients treated with methylprednisolone pulses vs oral glucocorticoids alone had lower exposure to prednisone at remission (median cumulative dose, 733 mg vs 1902 mg) and a lower average daily prednisone dose until remission (median, 13.6 mg vs 30.0 mg; P < .001 for both).
• At 3 months, patients treated with methylprednisolone pulses had lower rates of new-onset or worsening diabetes (4.3% vs 16.7%; P = .003) and osteoporosis (1.7% vs 7.8%; P = .035).

IN PRACTICE:

“By significantly shortening the time to remission, reducing cumulative prednisone exposure, and maintaining a favorable safety profile, [methylprednisolone] pulses could address critical unmet needs in a disease characterized by high morbidity and substantial vulnerability to [glucocorticoid]-related complications,” the authors of the study wrote.

SOURCE:

The study was led by Román Fernández Guitián, Hospital Universitario Puerta de Hierro, Majadahonda, Spain. It was published online on March 20, 2026, in Arthritis Research & Therapy.

LIMITATIONS: 

The retrospective study was prone to bias. The study population was heterogeneous, with variability in treatment strategies. The 3‐month follow-up period restricted the analysis of long-term outcomes.

DISCLOSURES:

The study was supported in part through the Santander Scholarships-Financial Aid for Postdoctoral Research Staff 2025 program. One author declared receiving honoraria for lectures from Roche.

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