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Published on: February 8, 2019
Treatment of giant-cell arteritis, a literature review
Bénédicte Watelet1, Maxime Samson2, Hubert de Boysson3
1a Department of Vascular Medicine , Centre Hospitalier Universitaire de Caen , Caen , Basse Normandie , France.
Insights
Giant-cell arteritis (GCA) treatment lacks international consensus. Oral corticosteroids are standard, but GC-sparing agents like methotrexate, cyclophosphamide, and tocilizumab are explored for steroid dependence or side effects.
Area of Science:
- Rheumatology
- Internal Medicine
- Vasculitis Research
Background:
- Giant-cell arteritis (GCA) is the most prevalent vasculitis affecting individuals over 50.
- Current therapeutic strategies for GCA lack international consensus.
- Managing GCA involves addressing disease activity and preventing long-term corticosteroid complications.
Purpose of the Study:
- To conduct an international literature review on GCA treatment modalities.
- To synthesize current evidence on the efficacy and limitations of various GCA therapies.
- To identify challenges in GCA management, including steroid-induced complications and thrombotic risks.
Main Methods:
- Systematic review of international literature on GCA treatment.
- Analysis of therapeutic options including corticosteroids, GC-sparing agents, and biologics.
- Evaluation of evidence for managing GCA complications like osteoporosis and arterial thrombosis.
Main Results:
- Oral corticosteroids are the primary treatment, with IV bolus for severe cases.
- Methotrexate shows limited efficacy; cyclophosphamide and tocilizumab show promise but need further validation.
- TNF-α blockers and azathioprine have yielded disappointing results.
- Preventing corticosteroid-induced osteoporosis and managing arterial thrombosis risk are significant challenges.
Conclusions:
- Established treatment protocols for GCA are lacking.
- Corticosteroids remain central, but GC-sparing agents are crucial for steroid-dependent or intolerant patients.
- Further research is needed to validate novel therapies and optimize GCA management strategies, including complication prevention.
Abstract:
Giant-cell arteritis (GCA) is the most common vasculitis in people aged more than 50 years. Despite the frequency of this disease, there is currently no international consensus on its therapeutic modalities. The aim of this study was to conduct a review on an international literature about the treatment of GCA, whatever the clinical pattern might be. Oral corticosteroids remain the cornerstone treatment, possibly preceded by intravenous bolus in complicated forms. In cases of glucocorticoid (GC) dependence or GC-related side effects, a GC-sparing agent may be necessary. Methotrexate is one of the most used treatments despite its low level of evidence and mild efficacy. Cyclophosphamide and tocilizumab look promising but require validation in further studies. The results for TNF-α blockers and azathioprine are disappointing. Preventing complications of prolonged corticosteroid therapy is a world challenge and the management of GC-induced osteoporosis is not the same from one country to another. There is a significant risk of arterial thrombosis, mainly at treatment onset, which may encourage to associate an antiplatelet therapy, especially in patients with other cardiovascular risk factors. Place of statins in the treatment of the disease is uncertain.
