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Updated: Nov 23, 2025
An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
Evaluation of adjunctive mycophenolate for large vessel giant cell arteritis
Maira Karabayas1,2, Paula Dospinescu2, Nick Fluck3
1Aberdeen Centre for Arthritis & Musculoskeletal Health, University of Aberdeen.
Insights
Mycophenolate (MYC) may effectively reduce corticosteroid (CS) use and is well-tolerated in patients with large vessel involvement in giant cell arteritis (LV-GCA). Further research is needed to confirm these findings in LV-GCA.
Area of Science:
- Rheumatology
- Immunology
- Vascular Medicine
Background:
- Giant cell arteritis (GCA) with large vessel involvement (LV-GCA) presents unique challenges, including higher corticosteroid (CS) requirements and relapse rates.
- Current treatment strategies for LV-GCA are not specifically optimized, necessitating investigation into alternative or adjunctive therapies.
Purpose of the Study:
- To evaluate the corticosteroid-sparing effect of first-line mycophenolate derivatives (MYC) in patients with LV-GCA.
- To assess the tolerability and efficacy of MYC in managing LV-GCA.
Main Methods:
- A retrospective cohort study identified 37 patients with LV-GCA diagnosed between 2005 and 2019.
- Patients received mycophenolate derivatives (MMF or MPA) at diagnosis and were followed for at least 2 years.
- Primary outcome: cumulative CS dose at 1 year. Secondary outcomes: MYC tolerance, relapse rates, and CRP levels.
Main Results:
- The mean cumulative prednisolone dose at 1 year was 4960 mg.
- Relapse rates were 16.2% at 1 year and 27% at 2 years.
- 31 of 37 patients remained on MYC for 2 years, with 6 switching to other agents due to relapse.
Conclusions:
- This study suggests that mycophenolate may be an effective and well-tolerated option for reducing CS exposure in LV-GCA.
- These findings represent the first assessment of a specific agent's effectiveness in LV-GCA.
- A randomized controlled trial is recommended to confirm the utility of MYC in this patient population.
Objectives:
GCA patients with large vessel involvement (LV-GCA) experience greater CS requirements and higher relapse rates compared with classical cranial GCA. Despite the distinct disease course, interventions in LV-GCA have yet to be investigated specifically. This study aimed to evaluate the CS-sparing effect and tolerability of first-line mycophenolate in LV-GCA.
Methods:
A retrospective cohort study was conducted in patients with LV-GCA identified from a regional clinical database between 2005 and 2019. All cases were prescribed mycophenolate derivatives (MYC; MMF or mycophenolic acid) at diagnosis and were followed up for ≥2 years. The primary outcome was the cumulative CS dose at 1 year. Secondary outcomes included MYC tolerance, relapse rates and CRP levels at 1 and 2 years.
Results:
A total of 37 patients (65% female; mean age 69.4 years, SD 7.9 years) were identified. All cases demonstrated large vessel involvement via CT/PET (n = 34), CT angiography (n = 5) or magnetic resonance angiography (n = 2). After 2 years, 31 patients remained on MYC, whereas 6 had switched to MTX or tocilizumab owing to significant disease relapse. The mean (±SD) cumulative prednisolone dose at 1 year was 4960 (±1621) mg. Relapse rates at 1 and 2 years were 16.2 and 27%, respectively, and CRP levels at 1 and 2 years were 4 [interquartile range (IQR) 4-6] and 4 (IQR 4-4) mg/l, respectively.
Conclusion:
To our knowledge, this is the first attempt to assess the effectiveness of any specific agent in LV-GCA. MYC might be both effective in reducing CS exposure and well tolerated in this subpopulation. A future randomized controlled trial is warranted.
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