Treatment of Giant Cell Arteritis (GCA)
Abstract
:1. Introduction
2. Glucocorticoids
3. Immunosuppressants
4. Biologic Agents
5. Future Perspectives
6. Therapeutic Strategy and International Recommendations
7. Non-Immunosuppressive Therapy
8. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Abbreviations
AZA | azathioprine |
GCs | glucocorticoids |
GCA | giant cell arteritis |
IL | interleukin |
IS | immunosuppressant |
IV | intravenous |
LEF | leflunomide |
MTX | methotrexate |
RCT | randomised controlled trial |
TCZ | tocilizumab |
TNF | tumor necrosis factor |
References
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Author, Year | Number of Patients | Disease Activity | Drug Evaluated | GC Therapy | Main Primary Outcome | Result |
---|---|---|---|---|---|---|
Azathioprine | ||||||
De Silva et al., 1986 | 31 | GCA in remission | Azathioprine 150 mg/day | GCs ≥ 5 mg/day Tapering 1 mg/month | Not specified (studied GCs daily dose) | Positive at month 12 |
Dapsone | ||||||
Liozon et al., 1993 | 48 | New-onset GCA | Dapsone 50–100 mg/day | 0.7–1.0 mg/kg/day Tapering ≈ 14 months | Relapses | Positive but dapsone-related side effects |
Hydroxychloroquine | ||||||
Sailler et al., 2009 | 74 | New-onset GCA | Hydroxychloroquine 400 mg/day | 0.7 mg/kg/day Tapering ≈ 16 months | Remission > 3 month at the end of follow-up | Negative and hydroxychloroquine-related side effects |
Methotrexate | ||||||
Spiera et al., 2001 | 21 | New-onset GCA | MTX 7.5–20 mg/week | >40 mg/day. Suggested tapering ≈ 4 months | Cumulative dose of GCs at year 2 | Negative |
Jover et al., 2001 | 42 | New-onset GCA | MTX 10 mg/week | 60 mg/day. Tapering ≈ 6 months | Cumulative dose of GCs and relapses | Positive |
Hoffman et al., 2002 | 98 | New-onset GCA | MTX 0.15–0.25 mg/kg/week; max 15 mg/week | 1 mg/kg/day and <60 mg/day; alternate day tapering ≈ 6 months | Relapses | Negative |
Cyclosporine A | ||||||
Schaufelberger et al., 2006 | 60 | New-onset GCA | CsA 2 mg/kg/day reduced or increased up to 3.5 mg/kg/day | Not specified | Cumulative dose of GCs and relapses | Negative. Numerous side effects |
Author, Year | Number of Patients | Disease Activity | Drug Evaluated | GC Therapy | Main Primary Outcome | Result |
---|---|---|---|---|---|---|
Anti-TNF therapy | ||||||
Hoffman et al., 2007 | 44 | New-onset GCA | Infliximab 5 mg/kg W0, 2 and 6 and every 8 weeks | Tapering < 6 months | Relapses at W22 | Negative |
Martinez-Taboadda et al., 2008 | 17 | GCA in remission under GC > 10 mg/day. GC-related side effects | Etanercept 25 mg × 2/week | Tapering < 4 months (depending on initial daily dose) | GC-free remission at M12 | Negative |
Seror et al., 2013 | 70 | New-onset GCA | Adalimumab 40 mg at W2, 4, 6, 8, 10 | 0.7 mg/kg. Tapering ≈ 10 months | Remission at W26 with GC < 0.1 mg/kg | Negative |
Abatacept (CTLA4–Ig) | ||||||
Langford et al., 2017 | 49 | New-onset or relapsing GCA Abatacept 10 mg/kg D1, 15, 29, 56 and GCs 40–60 mg/day for remission induction | 41 patients randomised at W12, abatacept 10 mg/kg/4 weeks | 20 mg/day at randomisation. Tapering until W28 | Relapse-free survival | Positive |
Tocilizumab (IL-6 receptor inhibitor) | ||||||
Villiger et al., 2016 | 30 | New-onset or relapsing | Tocilizumab 8 mg/kg/month | 1 mg/kg/day Tapering ≈ 9 months | Remission at W12 with GCs 0.1 mg/kg. Normal ESR and CRP | Positive |
Stone et al., 2017 | 251 | New-onset or relapsing | Tocilizumab 162 mg/week or 162 mg every other week | 20–60 mg/day. Tapering 26 or 52 weeks | Prednisone-free remission at W52 | Positive |
Mavrilimumab (GM-CSF receptor-α inhibitor) | ||||||
Cid et al., 2020 | 70 | New-onset or relapsing | Mavrilimumab 150 mg every other week | 20–60 mg/day. Tapering 26 weeks | Relapse at W26 | Positive |
Secukinumab (IL-17A inhibitor) | ||||||
Venhoff et al., 2021 | 52 | New-onset or relapsing | Secukinumab 300 mg/week (5 doses) then 300 mg/4 week until W48 | 25–60 mg/day. Tapering 26 weeks | Sustained remission at W28 | Positive |
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Régent, A.; Mouthon, L. Treatment of Giant Cell Arteritis (GCA). J. Clin. Med. 2022, 11, 1799. https://doi.org/10.3390/jcm11071799
Régent A, Mouthon L. Treatment of Giant Cell Arteritis (GCA). Journal of Clinical Medicine. 2022; 11(7):1799. https://doi.org/10.3390/jcm11071799
Chicago/Turabian StyleRégent, Alexis, and Luc Mouthon. 2022. "Treatment of Giant Cell Arteritis (GCA)" Journal of Clinical Medicine 11, no. 7: 1799. https://doi.org/10.3390/jcm11071799