Effective treatment of giant cell arteritis: A Synthesis of Findings from 19 Studies

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Original Abstract of the Article

Major Research Findings

Giant cell arteritis (GCA) is the most common systemic vasculitis in individuals aged 50 and above, with an incidence of 3.5 per 100,000 per year. 6 . It affects arteries in the head, aorta, and other parts of the body, such as the limbs. 6 . The gold standard for diagnosing GCA is a positive temporal artery biopsy. 10 . However, over the past 10 years, the introduction of new imaging techniques in GCA patients has revealed variable prevalence of extracranial involvement, challenging the temporal artery biopsy as the gold standard. 10 . Imaging has become crucial not only for diagnosing GCA but also for assessing vascular damage in GCA and evaluating treatment effectiveness. 10 .

Treatment for GCA typically involves high-dose corticosteroids. 8 . However, corticosteroids can lead to side effects, and further disease-related ischemic complications may still occur. 8 . Therefore, there is a need for therapies that reduce corticosteroid use or serve as alternatives. 8 .

Methotrexate (MTX) may reduce GCA relapses, decrease cumulative corticosteroid (CS) requirements, and diminish disease- and treatment-related morbidity. 5 . However, the steroid-sparing effect of MTX remains unclear. 1 . MTX is being explored as a potential alternative to corticosteroids in treating GCA. 3 .

Biological agents have been used with varying effectiveness in patients with LVV who cannot tolerate CS. 9 .

Tocilizumab has been shown to be effective in treating GCA. 13 . Tocilizumab has also demonstrated effectiveness in inducing and maintaining remission in patients with GCA. 11 .

Abatacept has been shown to be more effective than placebo in treating GCA. 12 .

Treatment Summary

Standard treatment for GCA involves high-dose corticosteroids. 8 . To mitigate corticosteroid side effects, medications such as methotrexate (MTX) and biological agents are sometimes used adjunctively. 5 , 9 . Tocilizumab has shown effectiveness in treating GCA. 13 , 11 . Abatacept has also demonstrated effectiveness in treating GCA. 12 .

Benefits and Risks

Benefit Summary

Treating GCA can reduce vascular inflammation and prevent complications like vision loss. 8 . Reducing corticosteroid use can lessen side effects. 5 .

Risk Summary

GCA treatment carries risks, including side effects from corticosteroids and other treatment medications. 8 . Corticosteroids can cause side effects like weight gain, high blood sugar, and osteoporosis. 8 . Biological agents may increase the risk of infections. 9 .

Comparison Across Studies

Similarities Across Studies

Numerous studies have shown that corticosteroids are effective in treating GCA. 2 , 8 , 9 , 13 , 11 , 12 . Several studies have shown that medications like MTX and biological agents are effective in reducing corticosteroid use or serving as alternatives for treating GCA. 5 , 1 , 3 , 9 , 13 , 11 , 12 .

Differences Across Studies

The effectiveness of MTX in treating GCA varies across studies. 5 , 1 , 3 . The effectiveness of biological agents also varies across studies. 9 .

Consistency and Inconsistencies of Results

Many questions remain regarding the treatment of GCA. 8 . For instance, it is unclear whether MTX and biological agents have a steroid-sparing effect, and which medication is most effective. 5 , 1 , 3 , 9 , 13 , 11 , 12 . To address these questions, further research is needed. 8 .

Real-World Application Considerations

Early diagnosis and prompt treatment are crucial for managing GCA. 8 . If you experience symptoms of GCA, seek medical attention immediately. 8 . Follow your doctor's instructions regarding GCA treatment. 8 .

Limitations of Current Research

Research on GCA is still limited. 8 . As a result, many questions remain regarding the treatment of GCA. 8 . Additionally, GCA is a rare disease, making it challenging to recruit patients for research studies. 8 .

Future Research Directions

To improve GCA treatment, research is needed in the following areas. 8 .

  • Studies on the steroid-sparing effects of MTX and biological agents
  • Research to identify the most effective medications for treating GCA
  • Studies on preventing GCA

Conclusion

GCA is a disease that can lead to serious complications. 8 . Early diagnosis and appropriate treatment are essential for preventing complications and improving the quality of life for patients. 8 .

Treatment List

Corticosteroids, methotrexate (MTX), biological agents, tocilizumab, abatacept

Literature analysis of 19 papers
Positive Content
17
Neutral Content
0
Negative Content
2
Article Type
9
6
7
4
18
1.

Can methotrexate be used as a steroid sparing agent in the treatment of polymyalgia rheumatica and giant cell arteritis?

Author: van der VeenM J, DinantH J, van Booma-FrankfortC, van Albada-KuipersG A, BijlsmaJ W

Reduced prednisone use

Methotrexate did not show a steroid-sparing effect in the treatment of polymyalgia rheumatica and giant cell arteritis when combined with a rapid steroid tapering regimen. The study found that the mean daily prednisone dose could be reduced by 50% in 21 weeks and discontinued in 40% of patients within two years.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

2.

A randomized, multicenter, controlled trial using intravenous pulses of methylprednisolone in the initial treatment of simple forms of giant cell arteritis: a one year followup study of 164 patients.

Author: ChevaletP, BarrierJ H, PottierP, Magadur-JolyG, PottierM A, HamidouM, PlanchonB, El KouriD, ConnanL, DupondJ L, De WazieresB, DienG, DuhamelE, GrosboisB, JegoP, Le StratA, CapdevilleJ, LetellierP, AgronL

Corticosteroid resistance
GCA complications
No long-term corticosteroid sparing

Methylprednisolone (MP) pulses have no significant long-term, corticosteroid sparing effects in the treatment of simple forms of giant cell arteritis (GCA) and should be limited to complicated forms. Corticosteroid resistance is a real risk factor for GCA complications.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

3.

A prospective, double-blind, randomized, placebo controlled trial of methotrexate in the treatment of giant cell arteritis (GCA).

Author: SpieraR F, MitnickH J, KupersmithM, RichmondM, SpieraH, PetersonM G, PagetS A

Methotrexate added to corticosteroid therapy for giant cell arteritis (GCA) did not show a corticosteroid-sparing benefit. Both groups had similar corticosteroid dose reductions and few major side effects.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

Effect of prior steroid treatment on temporal artery biopsy findings in giant cell arteritis.

Author: Ray-ChaudhuriN, KinéD Ah, TijaniS O, ParumsD V, CartlidgeN, StrongN P, DayanM R

Temporal artery biopsy effective after steroids

Temporal artery biopsy can be useful even after 4 weeks of corticosteroid treatment for giant cell arteritis.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

5.

A multicenter, randomized, double-blind, placebo-controlled trial of adjuvant methotrexate treatment for giant cell arteritis.

Author: HoffmanGary S, CidMaria C, HellmannDavid B, GuillevinLoic, StoneJohn H, SchousboeJohn, CohenPascal, CalabreseLeonard H, DicklerHoward, MerkelPeter A, FortinPaul, FlynnJohn A, LockerGeri A, EasleyKirk A, SchnedEric, HunderGene G, SnellerMichael C, TuggleCarol, SwansonHoward, Hernández-RodríguezJ, Lopez-SotoAlfons, BorkDebora, HoffmanDiane B, KalunianKenneth, KlashmanDavid, WilkeWilliam S, ScheetzRaymond J, MandellBrian F, FesslerBarri J, KosmorskyGregory, PraysonRichard, LuqmaniRaashid A, NukiGeorge, McRorieEuan, SherrerYvonne, BacaShawn, WalshBridgit, FerlandDiane, SoubrierMartin, ChoiHyon K, GrossWolfgang, SegalAllen M, LudivicoCharles, PuechalXavier,

No reduced cumulative corticosteroid dose
No reduced risk of treatment failure

Methotrexate did not reduce the risk of treatment failure or the cumulative dose and toxicity of corticosteroids in patients with GCA.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : English

6.

The diagnosis and treatment of giant cell arteritis.

Author: NessThomas, BleyThorsten A, SchmidtWolfgang A, LamprechtPeter

Visual function preservation
Aortic complications
Visual loss

Giant cell arteritis, if untreated, progresses to involve the aorta and its collateral branches, leading to various complications. Late diagnosis and treatment can have serious consequences, including irreversible loss of visual function.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

7.

Prednisolone combined with adjunctive immunosuppression is not superior to prednisolone alone in terms of efficacy and safety in giant cell arteritis: meta-analysis.

Author: YatesM, LokeY K, WattsR A, MacGregorA J

GCA treatment
Infection
Relapse

This meta-analysis investigated the effectiveness of drug treatment in giant cell arteritis (GCA). The study found that adjunct immunosuppressants did not improve outcomes, and that intravenous glucocorticoids (GCs) may be associated with a higher risk of infection.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.

Language : English

8.

Aspirin as adjunctive treatment for giant cell arteritis.

Author: MollanSusan P, SharrackNoor, BurdonMike A, DennistonAlastair K

GCA treatment

Giant cell arteritis (GCA), an inflammation of blood vessels, is common and can lead to sudden blindness. The standard treatment is high-dose corticosteroids, which can cause side effects and don't always prevent complications. Aspirin, which may reduce inflammation, is being explored as a potential alternative or additional treatment for GCA.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

9.

The role of biological agents in the management of large vessel vasculitis (LVV): a systematic review and meta-analysis.

Author: OsmanMohammed, PagnouxChristian, DrydenDonna M, StorieDale, YacyshynElaine

Reduced CS use
Remission

Biological agents, like anti-TNF agents, were not effective for remission or reduction of corticosteroid use in patients with giant cell arteritis (GCA). However, tocilizumab and infliximab may be effective for GCA and refractory Takayasu's arteritis (TAA), respectively, although more research is needed.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

10.

Vessel involvement in giant cell arteritis: an imaging approach.

Author: HolmPieter W, SandoviciMaria, SlartRiemer H J A, GlaudemansAndor W J M, RutgersAbraham, BrouwerElisabeth

Imaging for GCA

This research focuses on giant cell arteritis (GCA), a type of large vessel vasculitis. The study highlights the increasing use of imaging techniques for diagnosing GCA and assessing vascular damage, potentially challenging the traditional reliance on temporal artery biopsy as the gold standard.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

11.

Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial.

Author: VilligerPeter M, AdlerSabine, KuchenStefan, WermelingerFelix, DanDiana, FiegeVeronika, BütikoferLukas, SeitzMichael, ReichenbachStephan

Giant cell arteritis treatment

Giant cell arteritis (GCA) is an inflammatory condition that affects large arteries, mainly affecting people over 50. While corticosteroids are the standard treatment and can prevent serious complications, they can also cause harm. Tocilizumab, a medication that blocks a specific inflammatory protein, has shown promise in treating GCA. This study is the first randomized clinical trial to investigate the effectiveness and safety of tocilizumab in newly diagnosed or recurring GCA.

Clinical Trial, Phase IIA Phase II trial is a trial that further evaluates the efficacy and safety of a new drug or treatment, whose safety has been confirmed to some extent in a Phase I trial, in a small number of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

12.

A Randomized, Double-Blind Trial of Abatacept (CTLA-4Ig) for the Treatment of Giant Cell Arteritis.

Author: LangfordCarol A, CuthbertsonDavid, YtterbergSteven R, KhalidiNader, MonachPaul A, CaretteSimon, SeoPhilip, MorelandLarry W, WeismanMichael, KoeningCurry L, SreihAntoine G, SpieraRobert, McAlearCarol A, WarringtonKenneth J, PagnouxChristian, McKinnonKathleen, ForbessLindsy J, HoffmanGary S, BorchinRenée, KrischerJeffrey P, MerkelPeter A,

GCA treatment

Abatacept, a medication for giant cell arteritis (GCA), reduced the risk of relapse and was not associated with a higher rate of toxicity compared to prednisone alone. Patients receiving abatacept experienced a longer duration of remission than those receiving placebo.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

13.

Tocilizumab vs placebo for the treatment of giant cell arteritis with polymyalgia rheumatica symptoms, cranial symptoms or both in a randomized trial.

Author: SpieraRobert, UnizonySebastian H, BaoMin, LuderYves, HanJian, PavlovAndrey, StoneJohn H

Tocilizumab was found to be effective in patients with giant cell arteritis presenting with polymyalgia rheumatica symptoms only, cranial symptoms only, or both.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

14.

Efficacy and safety of steroid-sparing treatments in giant cell arteritis according to the glucocorticoids tapering regimen: A systematic review and meta-analysis.

Author: GérardAnne-Laure, Simon-TillauxNoémie, YordanovYouri, CacoubPatrice, TubachFlorence, SaadounDavid, DechartresAgnès

Relapse reduction

Tocilizumab is effective in reducing the relapse rate in GCA at week 52, but the quality of evidence was moderate. No other molecule has shown efficacy.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

15.

Treatment failure in giant cell arteritis.

Author: UnizonySebastian H, BaoMin, HanJian, LuderYves, PavlovAndrey, StoneJohn H

Treatment success
Treatment failure

Treatment failure was significantly less likely in the tocilizumab plus prednisone group than the placebo plus prednisone group. Risk for treatment failure was significantly higher in women than men in the placebo plus prednisone group but not in the tocilizumab plus prednisone group.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

16.

Endovascular Therapy for Intracranial Giant Cell Arteritis : Systematic Review, Technical Considerations and the Effect of Intra-arterial Calcium Channel Blockers.

Author: CatonM Travis, MarkIan T, NarsinhKazim H, BakerAmanda, CookeDaniel L, HettsSteven W, DowdChristopher F, HalbachVan V, HigashidaRandall T, KoNerissa U, ChungSharon A, AmansMatthew R

EVT for intracranial GCA

Giant cell arteritis (GCA) is a rare condition that can cause ischemic stroke. In some cases, GCA may lead to aggressive intracranial stenoses that are resistant to medical therapy. Endovascular treatment (EVT) offers a potential rescue strategy to prevent ischemic complications, but its safety and effectiveness in this setting need further investigation.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

17.

Duration of Treatment With Glucocorticoids in Giant Cell Arteritis: A Systematic Review and Meta-analysis.

Author: MoreelLien, BetrainsAlbrecht, MolenberghsGeert, BlockmansDaniel, VanderschuerenSteven

Prolonged GC treatment for GCA

This meta-analysis estimated the mean duration of glucocorticoid (GC) treatment in patients with giant cell arteritis, finding that a considerable proportion of patients require prolonged GC treatment and that a predefined GC-tapering schedule may help to avoid overly long treatment.

Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

19.

Measuring treatment outcomes and change in disease activity in giant cell arteritis: a systematic literature review informing the development of the EULAR-ACR response criteria on behalf of the EULAR-ACR response criteria in giant cell arteritis task force.

Author: Sanchez-AlvarezCatalina, BondMilena, SoowamberMedha, CamellinoDario, AndersonMelanie, LangfordCarol A, DejacoChristian, ToumaZahi, RamiroSofia

There is currently no unified definition of response to treatment in giant cell arteritis (GCA), highlighting the need for standardized criteria.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

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