Materiały źródłowe

• #1 Giant Cell Arteritis (Temporal Arteritis) Treatment & Management: Approach Considerations, Alternatives to Corticosteroids, Diet and Activity

  https://emedicine.medscape.com/article/332483-treatment

  The universally accepted treatment of giant cell arteritis (GCA) is high-dose corticosteroid therapy. The major justification for the use of corticosteroids is the impending danger of blindness in untreated patients. Patients who present with visual symptoms have a 22-fold increased chance of visual improvement if therapy is started within the first day. Damage may be irreversible if treatment is delayed beyond 48 hours. […] Few studies exist regarding dosing protocols for corticosteroids in GCA. It is generally agreed that most patients with suspected GCA should be started on oral prednisone 40-60 mg/day, with a temporal artery biopsy performed within 1 week. Prednisone doses of 80-100 mg/day have been suggested for patients with visual or neurologic symptoms of GCA. Follow-up care within 72 hours after starting therapy should be arranged.

• #1 Giant Cell Arteritis (Temporal Arteritis) Treatment & Management: Approach Considerations, Alternatives to Corticosteroids, Diet and Activity

  https://emedicine.medscape.com/article/332483-treatment

  Alternatively, patients with acute visual changes from GCA can be started on intravenous (IV) methylprednisolone at a dose of 1,000 mg daily for 3 days. Limited data suggest that initial high-dose IV corticosteroid treatment (eg, methylprednisolone, 15 mg/kg of ideal body weight/day) may improve rates of sustained remission. However, further study is warranted before this is routinely practiced. […] Retrospective but impressive data from Nesher and colleagues support the use of low-dose aspirin (81 mg) in patients with GCA for prevention of visual loss and stroke. This therapy should be considered for patients diagnosed with GCA who do not have contraindications to its use. […] Improvement of systemic symptoms (eg, headache, lethargy) typically occurs within 72 hours of initiation of therapy. The elevation in erythrocyte sedimentation rate (ESR) and ischemic manifestations (eg, temporal headache, jaw claudication) diminish in several days. The ESR often drops even in patients with a normal baseline reading.

• #1 Giant Cell Arteritis (Temporal Arteritis) Treatment & Management: Approach Considerations, Alternatives to Corticosteroids, Diet and Activity

  https://emedicine.medscape.com/article/332483-treatment

  High-dose steroid therapy should be maintained only long enough for symptoms to resolve. Steroids should then be tapered slowly to the lowest dose required to suppress symptoms. Both clinical signs and sequential measurements of the ESR (or C-reactive protein level) assist in monitoring the patient’s response. Patients with visual involvement usually require slower tapering of corticosteroids. […] British guidelines recommend the following schedule for tapering of standard-regimen corticosteroids: Continue prednisolone, 40-60 mg (not 0.75 mg/kg) for 4 weeks (or until symptoms and laboratory abnormalities resolve), then reduce dose by 10 mg every 2 weeks to 20 mg, then reduce dose by 2.5 mg every 2-4 weeks to 10 mg, then reduce dose by 1 mg every 1-2 months, provided no relapse occurs. […] Patients on steroid therapy may receive prophylactic treatment with the following medications: Low-dose aspirin, 81 mg per day to decrease cranial ischemic complications; Proton pump inhibitor for gastrointestinal protection; Bisphosphonate, calcium, and vitamin D for bone protection.

• #1 Giant Cell Arteritis (Temporal Arteritis) Treatment & Management: Approach Considerations, Alternatives to Corticosteroids, Diet and Activity

  https://emedicine.medscape.com/article/332483-treatment

  Sequential ESR determination may assist in determining the success of corticosteroid therapy. Once the signs of clinical inflammation are suppressed and the ESR is maintained at a low level, corticosteroids may be tapered. In almost all patients, the steroid dosage can be significantly decreased; however, the inflammatory process may ebb and flow, and temporary dose increases may be needed to control disease flares. Relapse occurs in 25-60% of cases. […] No absolute guidelines exist as to the length of treatment with corticosteroids for GCA. It may be reasonable to maintain the patient on treatment for 2 years to lessen the chances for relapses. Even then, relapses have been reported. Some patients may need treatment for as long as 5 years. […] Long-term corticosteroid therapy has frequent and potentially serious consequences, including diabetes mellitus, vertebral compression fractures, steroid myopathy, steroid psychosis, and immunosuppression-related infections. Indeed, the cumulative morbidity associated with long-term therapy often exceeds that of the underlying disease.

• #1 Giant Cell Arteritis (Temporal Arteritis) Treatment & Management: Approach Considerations, Alternatives to Corticosteroids, Diet and Activity

  https://emedicine.medscape.com/article/332483-treatment

  Aspirin may be used in a low dose to inhibit platelet aggregation and improve the complications of venous stasis and thrombosis. Low-dose aspirin decreases the rates of visual loss and strokes in patients with GCA. […] Treat-to-target recommendations for GCA by an international group of experts include the following monitoring schedules: Every 1-4 weeks until remission has been achieved; Every 3-6 months in patients in stable remission on therapy; Individualized for patients off therapy.

• #1 Giant Cell Arteritis (Temporal Arteritis) Treatment & Management: Approach Considerations, Alternatives to Corticosteroids, Diet and Activity

  https://emedicine.medscape.com/article/332483-treatment

  Interleukin-6 (IL-6) plays a role in the inflammation of GCA. Treatment of GCA with the IL-6 receptor blocker tocilizumab has been shown to result in faster achievement of remission, with significant reduction in corticosteroid doses, and prolonged maintenance of remission. In 2017, the US Food and Drug Administration (FDA) expanded the indications for use of tocilizumab for use in GCA. […] Alternative immunosuppressant agents (eg, cyclosporine, azathioprine, methotrexate) may be started later in the course of treatment. They can be useful as steroid-sparing agents in patients who require prolonged treatment with high doses of steroids (more than 5-10 mg/d) and those who experience significant steroid-related complications. […] Most patients with GCA can be treated on an outpatient basis. Hospital admission may be indicated for patients with particularly severe symptoms or those unable to provide self-care at home. After resolution of acute GCA, patients require regular followup to monitor for disease recurrence, steroid complications during steroid therapy, and long-term complications such as aortic aneurysm.

• #1 FDA approves first drug to specifically treat giant cell arteritis | FDA

  https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-specifically-treat-giant-cell-arteritis

  The U.S. Food and Drug Administration today expanded the approved use of subcutaneous Actemra (tocilizumab) to treat adults with giant cell arteritis. This new indication provides the first FDA-approved therapy, specific to this type of vasculitis. […] Standard treatment involves high doses of corticosteroids that are tapered over time. […] The efficacy and safety of subcutaneous (injected under the skin) Actemra for giant cell arteritis were established in a double-blind, placebo-controlled study with 251 patients with giant cell arteritis. […] A greater proportion of patients receiving subcutaneous Actemra with standardized prednisone regimens achieved sustained remission from Week 12 through Week 52 as compared to patients receiving placebo with standardized prednisone regimens. […] The overall safety profile observed in the Actemra treatment groups was generally consistent with the known safety profile of Actemra. […] Actemra should be used with caution in patients at increased risk of gastrointestinal perforation.

• #1 Temporal arteritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5765614/

  The consensus is that high-dose oral steroids be maintained for a minimum of 4 weeks and thereafter a tapering of the dose is initiated, depending upon symptom and inflammatory markers returning to normal. […] Long-term steroid treatment is not without risk and may be associated with systemic complications such as osteoporosis, diabetes, hypertension, and an increased risk of infection, as well as local ocular complications such as cataract. […] Azathioprine, methotrexate, cyclophosphamide, cyclosporine, and cytokine blockade with various tumor necrosis factor antagonists have been tried. Methotrexate has been shown to reduce the risk of first and second relapse as well as reduce the total dose of steroid. […] Azathioprine has also shown a steroid-sparing effect, but due to the heterogeneous nature of the subjects enrolled, some of whom were GCA patients, more generalized conclusions cannot be made.

• #1 Pharmacological advances in giant cell arteritis treatment

  https://www.explorationpub.com/Journals/eaa/Article/100954

  Tocilizumab has shown safety and efficacy in reducing exacerbations and decreasing the daily dose of CSs, and is the only drug to be cleared by the FDA and EDC for the treatment of GCA and this reason it was immediately incorporated into clinical practice. […] Mavrilimumab is well tolerated and presents itself as a promising treatment option. […] Anakinra appears to have a steroid sparing effect, with good tolerance even over an extended period of time, and may be effective on large-vessel involvement. […] The 4 mg/day dose appears to have sufficient control over both GC tapering and discontinuation (only 1 out of 14 patients had a flare) with the ability to discontinue cortisone 22 weeks after initiation of therapy, with 13 out of 14 patients achieved and maintained clinical remission at 52 weeks.

• #1 Giant cell arteritis: Current treatment and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4468893/

  Glucocorticoids remain the cornerstone of medical therapy in giant cell arteritis (GCA) and should be started immediately to prevent severe consequences of the disease, such as blindness. […] However, glucocorticoid therapy leads to significant toxicity in over 80% of the patients. Various steroid-sparing agents have been tried, but robust scientific evidence of their efficacy and safety is still lacking. Tocilizumab, a monoclonal IL-6 receptor blocker, has shown promising results in a number of case series and is now being tested in a multi-centre randomized controlled trial. […] The need for surgical treatment is rare and should ideally be performed in a quiescent phase of the disease. Not all patients follow the same course, but there are no valid biomarkers to assess therapy response. Monitoring of disease progress still relies on assessing clinical features and measuring inflammatory markers (C-reactive protein and erythrocyte sedimentation rate). […] Although GCA is the most common form of primary vasculitis, the optimal strategies for treatment and monitoring remain uncertain.

• #1 Giant cell arteritis: Current treatment and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4468893/

  The use of antiplatelet agents in GCA is controversial. […] However, in addition to its antiplatelet effects, aspirin may have a disease modifying effect in GCA. […] Nevertheless, the use of low-dose aspirin (75-150 mg/d) is routinely recommended for patients with GCA in the absence of contraindications. […] The treatment of GCA requires both long-term and high dose glucocorticoid therapy. […] Calcium in isolation appears to have little effect in preventing bone loss in patients starting glucocorticoids although when combined with vitamin D, it is an appropriate adjunctive treatment. […] Bisphosphonates are indicated in accordance with local guidelines. […] Despite the severe consequences of untreated GCA, such as blindness, there is no consensus on the optimal therapeutic strategies for this disease. […] Early initiation of glucocorticoid treatment is essential; however, the value of additional steroid-sparing synthetic or biologic agents to avoid the common glucocorticoid adverse effects or obtain quicker remission is still uncertain.

• #1 Giant Cell Arteritis Part 2: Treatment | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/giant-cell-arteritis-part-2-treatment/

  For major relapses, patients should be treated similar to new-onset GCA, with prednisone 40-60 mg per day, followed by a taper in the usual fashion. For minor relapses, prednisone should be increased to the last effective dose or 5-15 mg above their current dose. If the patient was not placed on a steroid-sparing agent as upfront therapy, we recommend initiating one at the time of relapse. […] Currently, there is some evidence for both tocilizumab and methotrexate as steroid-sparing agents for the treatment of GCA. Leflunomide is also considered useful by most experts, although its evidence in GCA is sparse. These agents should be initiated by a rheumatologist, and used in conjunction with a prednisone taper. Tocilizumab has been shown to reduce total glucocorticoid exposure as well as risk of relapse in patients with GCA. Methotrexate has demonstrated modest reductions in relapse risk and steroid-sparing effects.

• #1 Giant cell arteritis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/symptoms-causes/syc-20372758

  Prompt treatment with corticosteroid medications usually relieves symptoms of giant cell arteritis and might prevent loss of vision. […] You’ll need to visit your doctor regularly for checkups and treatment of any side effects from taking corticosteroids. […] If you’re diagnosed with giant cell arteritis, starting treatment as soon as possible can usually help prevent vision loss.

• #1 Giant Cell Arteritis (Temporal Arteritis) – Harvard Health

  https://www.health.harvard.edu/a_to_z/giant-cell-arteritis-temporal-arteritis-a-to-z

  Some studies have found that another medication, methotrexate (Folex, Rheumatrex), may reduce the dose of corticosteroids required and the length of time they need to be taken, although other studies have not confirmed this. As a result, some physicians prescribe methotrexate as a „steroid-sparing” agent in the hopes of reducing the overall exposure to corticosteroids. However, the evidence to date suggests that tocilizumab is more effective than methotrexate as a steroid-sparing drug. […] The use of steroids can lead to complications, including osteoporosis, diabetes, and weight gain; measures to prevent these complications (such as supplemental calcium and vitamin D) are routinely recommended. Bone density testing is also recommended to monitor bone density and identify osteoporosis. Research is ongoing to identify other effective steroid-sparing medications. […] Some research suggests that low-dose aspirin may help to prevent complications of giant cell arteritis, including loss of vision. While the true impact of aspirin is uncertain, it is often recommended along with steroid therapy for this condition.

• #1 Temporal arteritis (Giant Cell Arteritis)

  https://neurologynetwork.com.au/neuro-ophthalmology/giant-cell-arteritis/

  Taking both a steroid and aspirin can greatly increase your risk of developing a stomach ulcer. If you take this combination of drugs it is commonly advised that you also take a drug to reduce the acid in your stomach. The aim is to prevent the serious complication of a bleeding stomach ulcer from developing. […] Proton pump inhibitors (PPIs) are a class (group) of drugs that work on the cells that line the stomach, reducing the production of acid. They include: esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole, and come in various different brand names. One of these will normally be advised if you take a steroid and aspirin.

• #1 Giant Cell Arteritis (Temporal Arteritis) — Chelsea and Westminster Hospital NHS Foundation Trust

  https://www.chelwest.nhs.uk/your-visit/patient-leaflets/medicine-services/giant-cell-arteritis-temporal-arteritis

  There is a pathway for suspected giant cell arteritis (GCA) within the Ambulatory Emergency Care (AEC) unit. Whilst undergoing diagnostic tests, you will be treated with high-dose steroids immediately (usually prednisolone tablets). This is necessary to reduce the risk of permanent visual loss but these are not the same steroids taken by bodybuilders. […] If the diagnosis of GCA is confirmed, you will be followed up in the rheumatology clinic. You will need several follow-up appointments with your rheumatologist to monitor symptoms as they gradually reduce your steroid dose. You should keep taking the prescribed steroid dose even if symptoms improve as this can help prevent another episode. […] There are some side effects of steroid medication which your doctor will discuss with you. […] While on steroids, you should carry a steroid card at all times. This alerts doctors that you require steroids should you become unwell and need hospitalisation. […] You are still able to take the COVID-19 and flu vaccines if desired. Steroid use can affect your ability to fight infections so getting vaccinated against flu and COVID-19 is especially important.

• #1 Advances in the Treatment of Giant Cell Arteritis

  https://www.mdpi.com/2077-0383/11/6/1588

  In fact, around 50% of patients relapse when the dose is reduced below 15–20 mg/day, especially the extracranial forms, so it is necessary to associate csDMARDs or biological therapy. […] Among the csDMARDs, MTX is the only one that seems to have a favorable relationship between efficacy and safety to reduce relapses and decrease the accumulated doses of GC in the long term, especially in patients who are dependent on GC or at a high risk of complications derived from GC use. […] TCZ, an IL-6 receptor inhibitor, has been demonstrated to increase the remission rate, reduce the number of recurrences, and achieve a lower cumulative dose of GC, making it currently the second line of therapy for GCA. […] Improvements in the understanding of the pathogenesis of the disease have opened up new roads and therapeutic opportunities in GCA.

• #1 Giant Cell Arteritis – Vasculitis Foundation

  https://vasculitisfoundation.org/education/vasculitis-types/giant-cell-arteritis/

  Even with effective treatment, relapse of GCA is common. […] Effective treatment of GCA may require the coordinated efforts and ongoing care of a team of medical providers and specialists. […] There is no cure at this time for GCA, but with early treatment and careful monitoring, most patients with GCA have a good prognosis. […] Newer medications such as the biologic drug, tocilizumab, offer hope for treating this disease with less exposure to corticosteroids.

• #2

  https://bpac.org.nz/bpj/2013/june/arteritis.aspx

  Giant cell arteritis, also referred to as temporal arteritis, is a form of vasculitis which predominantly affects older people. It must be treated urgently, as it is associated with a significant risk of permanent visual loss, stroke, aneurysm and possible death. […] A low threshold for suspicion and prompt corticosteroid treatment are essential to prevent these complications. […] The first steps for most patients should be to provide a prescription for corticosteroids and to contact either an Ophthalmologist or Rheumatologist (depending on local referral criteria) to organise a temporal artery biopsy. […] Urgent referral, i.e. within one week, to hospital for biopsy and an assessment of vision is required. […] The need for biopsy should never delay treatment. […] Most guidelines recommend oral prednisone 40 60 mg, once daily, for patients with giant cell arteritis, with the higher dose used in patients with ischaemic symptoms.

• #2 Temporal arteritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5765614/

  Temporal arteritis, also termed giant cell arteritis (GCA), is an immune-mediated vasculitis that affects medium and large vessels. […] The treatment of temporal arteritis revolves around high-dose initial IV or oral steroids followed by a tapering steroid dose depending upon the clinical response. […] It is recommended that high-dose steroids be used. Some regimens recommend IV methylprednisolone of 1 mg/kg per day for 3 days followed by oral steroids. Other regimens suggest the use of 40 to 60 mg per day of oral steroids initially. Treatment should be begun immediately following the clinical suspicion of the diagnosis and should not be delayed while waiting for the results of a temporal artery biopsy. […] Once again, corticosteroids are the mainstay of treatment. […] Treatment response to high-dose steroids tends to occur within 24 to 72 hours of therapy.

• #2 Treatment of giant cell arteritis – UpToDate

  https://www.uptodate.com/contents/treatment-of-giant-cell-arteritis

  Treatment of giant cell arteritis […] INITIAL MANAGEMENT […] No visual loss at diagnosis […] Glucocorticoids — For all patients with giant cell arteritis (GCA), we recommend initial treatment with high-dose glucocorticoids rather than a moderate dose of glucocorticoids. The specific dose and route of administration of glucocorticoids for newly diagnosed GCA varies depending on whether the patient presents with or without threatened or established visual loss at diagnosis. […] For patients without signs of ischemic organ damage (eg, visual loss), we initiate glucocorticoid therapy with prednisone 40 to 60 mg/day (or equivalent) administered in a single daily dose, with the goal of relieving symptoms and preventing visual loss. In selected cases in which reversible symptoms persist or worsen, the dose can be increased until symptomatic control is achieved (up to a maximum of prednisone 80 mg or equivalent).

• #2 Giant cell arteritis: Current treatment and management

  https://www.wjgnet.com/2307-8960/full/v3/i6/484.htm

  Treatment with high doses of glucocorticoids should be initiated as early as possible to prevent ischaemic manifestations, such as blindness (occurring in up to 20%). […] However, glucocorticoid therapy leads to significant toxicity in over 80% of the patients. Various steroid-sparing agents have been tried, but robust scientific evidence of their efficacy and safety is still lacking. […] The key issues in managing GCA after its diagnosis are prompt institution of correct therapy; recognition and amelioration of the adverse events related to immunosuppressant medications; and rapid identification of disease activity and flares. […] Induction treatment with high-dose pulsed intravenous (IV) methylprednisolone (15 mg/kg for 3 consecutive days followed by oral prednisone dose of 40 mg/d) has been suggested for all patients with GCA to allow faster tapering and a lower cumulative steroid dose in a double-blind, placebo-controlled, randomized trial involving 27 patients. […] Nevertheless, when a patient has an unacceptable high-risk of glucocorticoid-related side effects, such as concomitant severe osteoporosis and poorly controlled high blood pressure or diabetes mellitus, it might be feasible to add another immunosuppressive (e.g., methotrexate) at the onset of the disease to allow a safer and faster tapering of glucocorticoids.

• #2 Giant Cell Arteritis – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/vasculitis/giant-cell-arteritis

  Most patients require at least 2 years of treatment with corticosteroids. Long-term use of corticosteroids can have significant adverse effects and thus should be limited if possible. […] Tocilizumab, an interleukin (IL)-6 receptor antagonist, should be considered when treatment with corticosteroids is initiated, which allows for an accelerated corticosteroid tapering regimen. […] Low-dose aspirin (81 to 100 mg orally once a day) may help prevent ischemic events and should be considered for patients who have critical or flow-limiting involvement of the vertebral or carotid arteries.

• #2 Giant Cell Arteritis Part 2: Treatment | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/giant-cell-arteritis-part-2-treatment/

  Treatment with high-dose glucocorticoids should be initiated immediately upon clinical suspicion of GCA. The treatment should not be delayed to facilitate the temporal artery biopsy. Glucocorticoids are the gold-standard agents for GCA. Patients who present with ischemic complications such as vision loss, amaurosis fugax, or stroke should receive pulse steroids with methylprednisolone 500-1000 mg IV daily for 3 days, followed by 60 mg of prednisone daily, although the evidence for this is sparse. For patients without ischemic complications, Prednisone 40-60 mg should be started. We do not recommend starting doses higher than 60 mg regardless of the patients weight. We recommend tapering prednisone after 2-4 weeks of initiation. […] There is no high-quality evidence comparing different tapering schedules in patients with GCA. In most cases, prednisone should be tapered to less than 20 mg a day within 2 months. From the initial dose of 40-60 mg, we suggest lowering the dose by 10 mg every 2 weeks until a dose of 20 mg is reached, followed by reducing the dose by 2.5 mg every 2 weeks until 10 mg is reached. From 10 mg, the dose should be decreased by 1 mg every 2-4 weeks. Patients should ideally be on doses less than 5 mg by the 1-year mark. Anecdotally, many patients will require prednisone for up to 2 years. Patients should be dosed with prednisone daily, as dosing on alternate days is associated with higher rates of relapse.

• #2 Temporal arteritis

  https://www.nhs.uk/conditions/temporal-arteritis/

  Temporal arteritis is treated with steroid medicine, usually prednisolone. […] Treatment will be started before temporal arteritis is confirmed because of the risk of vision loss if it’s not dealt with quickly. […] There are 2 stages of treatment: An initial high dose of steroids for a few weeks to help bring your symptoms under control. […] A lower steroid dose (after your symptoms have improved) given over a longer period of time, possibly several years. […] A small number of people may need to take steroids for the rest of their life. […] You’ll have regular follow-ups to see how you’re doing and check for any side effects you may have. […] You may also need to take other types of medicine if you have temporal arteritis, including: low-dose aspirin to reduce the risk of a stroke or heart attack, which can happen if the arteries to your heart are affected.

• #2 Can Giant Cell Arteritis Be Cured?

  https://www.healthline.com/health/can-giant-cell-arteritis-be-cured

  If you’ve already lost vision, you may get even higher doses of a steroid drug delivered through an IV into a vein. […] Your doctor will monitor your symptoms and measure levels of inflammatory markers in your blood to determine what dose you need. […] You may have to stay on a steroid drug for up to 2 years to keep GCA under control. […] Methotrexate is another drug your doctor might prescribe if a steroid drug isn’t helping enough, or it causes side effects that you can’t tolerate. […] GCA isn’t curable, but long-term treatment with steroid medications can put you into remission. If this treatment doesn’t work, or it causes side effects that you can’t tolerate, your doctor might also give you methotrexate or Actemra. […] Researchers are studying several other drugs for GCA. The hunt is on for treatments that work as well as or better than steroids, but with fewer side effects.

• #2 Giant Cell Arteritis (Temporal Arteritis): Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/332483-overview

  Prompt initiation of treatment may prevent blindness and other potentially irreversible ischemic sequelae of GCA. […] Corticosteroids are the mainstay of therapy. In steroid-resistant cases, drugs such as tocilizumab, cyclosporine, azathioprine, or methotrexate may be used as steroid-sparing agents. The typical patient with GCA remains on steroid therapy for roughly 2 years. […] With prompt, adequate therapy, full recovery is the rule. Symptoms from temporal arteritis improve within days of treatment. Corticosteroids can usually be tapered within the first 4-6 weeks and eventually discontinued. […] The average duration of treatment is 2 years; however, some patients require treatment for 5 years or more. […] Cytotoxic or immunosuppressive drugs have been recommended in such cases, but more data are needed.

• #2 FDA approves first drug to specifically treat giant cell arteritis | FDA

  https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-specifically-treat-giant-cell-arteritis

  The U.S. Food and Drug Administration today expanded the approved use of subcutaneous Actemra (tocilizumab) to treat adults with giant cell arteritis. This new indication provides the first FDA-approved therapy, specific to this type of vasculitis. […] Standard treatment involves high doses of corticosteroids that are tapered over time. […] The efficacy and safety of subcutaneous (injected under the skin) Actemra for giant cell arteritis were established in a double-blind, placebo-controlled study with 251 patients with giant cell arteritis. […] A greater proportion of patients receiving subcutaneous Actemra with standardized prednisone regimens achieved sustained remission from Week 12 through Week 52 as compared to patients receiving placebo with standardized prednisone regimens. […] The overall safety profile observed in the Actemra treatment groups was generally consistent with the known safety profile of Actemra. […] Actemra should be used with caution in patients at increased risk of gastrointestinal perforation.

• #2 Pharmacological advances in giant cell arteritis treatment

  https://www.explorationpub.com/Journals/eaa/Article/100954

  A granulomatous vasculitis of the medium and large vessels, giant cell arteritis (GCA) is a persistent, idiopathic condition. […] The cornerstone of treatment for GCA is glucocorticoids, but using them for an extended period has numerous, often severe, side effects. […] By now, only tocilizumab is approved for GCA treatment, but several other biological drugs may be efficient and safe for GCA patients, like abatacept, baricitinib and upadacitinib, mavrilimumab, secukinumab, ustekinumab, and anakinra. […] The first line of therapy for GCA has been systemic glucocorticoids (CSs) since their development in the 1950s. […] The response to CSs is so rapid that it is a diagnostic criterion of GCA: Most symptoms improve after 2 or 3 days of therapy, while symptoms related to blood flow, such as jaw claudication and visual impairment, can take longer to resolve.

• #2 Giant Cell Arteritis (GCA) Treatment | ACTEMRA® (tocilizumab)

  https://www.actemra.com/gca.html

  ACTEMRA is used: […] To treat adults with giant cell arteritis (GCA) […] ACTEMRA is a prescription medicine called an interleukin-6 (IL-6) receptor antagonist. […] You may qualify for help paying for ACTEMRA, even if you are underinsured or on Medicare. […] Your healthcare provider should assess you for TB before starting, during and after treatment with ACTEMRA (except if you have COVID-19). […] If you have rheumatoid arthritis (RA) or giant cell arteritis (GCA), or systemic sclerosis-interstitial lung disease (SSc-ILD) your healthcare provider should do blood tests 4 to 8 weeks after you start receiving ACTEMRA for the first 6 months and then every 3 months after that. […] You should not receive ACTEMRA if your neutrophil and platelet counts are too low or your liver function test levels are too high.

• #2 Giant cell arteritis: Current treatment and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4468893/

  The search for an effective disease-modifying agent for the treatment of GCA has proven elusive. […] However, given the significant burden of morbidity associated with long term glucocorticoid treatment, current BSR guidelines for the management of GCA recommend consideration of the early introduction of methotrexate or alternative immunosuppressant therapy following a relapse. […] A number of drugs have been studied, with disappointing results to date. […] More recently, treatment with tocilizumab, a monoclonal IL-6 receptor blocker, has shown potential in a number of case studies and case series in the treatment of patients with PMR and GCA in terms of improvement of clinical symptoms and reduction in the acute phase response. […] GiACTA is a multicentre, randomised, double-blind, placebo controlled trial designed to test the ability of tocilizumab to maintain disease remission in GCA and is currently ongoing.

• #2 Giant Cell Arteritis (Temporal Arteritis) – Harvard Health

  https://www.health.harvard.edu/a_to_z/giant-cell-arteritis-temporal-arteritis-a-to-z

  Some studies have found that another medication, methotrexate (Folex, Rheumatrex), may reduce the dose of corticosteroids required and the length of time they need to be taken, although other studies have not confirmed this. As a result, some physicians prescribe methotrexate as a „steroid-sparing” agent in the hopes of reducing the overall exposure to corticosteroids. However, the evidence to date suggests that tocilizumab is more effective than methotrexate as a steroid-sparing drug. […] The use of steroids can lead to complications, including osteoporosis, diabetes, and weight gain; measures to prevent these complications (such as supplemental calcium and vitamin D) are routinely recommended. Bone density testing is also recommended to monitor bone density and identify osteoporosis. Research is ongoing to identify other effective steroid-sparing medications. […] Some research suggests that low-dose aspirin may help to prevent complications of giant cell arteritis, including loss of vision. While the true impact of aspirin is uncertain, it is often recommended along with steroid therapy for this condition.

• #2 Giant Cell Arteritis : Johns Hopkins Vasculitis Center

  https://www.hopkinsvasculitis.org/types-vasculitis/giant-cell-arteritis/

  Methotrexate, azathioprine, and cyclophosphamide have been used in rare patients who do not respond to adequate prednisone. Longterm followup is required to detect late recurrences (including the late onset of thoracic aortic aneurysms with aortic regurgitation, congestive heart failure, and aortic dissection). Patients with polymyalgia rheumatica but no symptoms of giant cell arteritis above the neck (such as jaw claudication, headache and visual symptoms) do not need temporal artery biopsy and respond to low-dose prednisone (10 to 20 mg/d orally).

• #2 Temporal arteritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5765614/

  The consensus is that high-dose oral steroids be maintained for a minimum of 4 weeks and thereafter a tapering of the dose is initiated, depending upon symptom and inflammatory markers returning to normal. […] Long-term steroid treatment is not without risk and may be associated with systemic complications such as osteoporosis, diabetes, hypertension, and an increased risk of infection, as well as local ocular complications such as cataract. […] Azathioprine, methotrexate, cyclophosphamide, cyclosporine, and cytokine blockade with various tumor necrosis factor antagonists have been tried. Methotrexate has been shown to reduce the risk of first and second relapse as well as reduce the total dose of steroid. […] Azathioprine has also shown a steroid-sparing effect, but due to the heterogeneous nature of the subjects enrolled, some of whom were GCA patients, more generalized conclusions cannot be made.

• #2 Giant cell arteritis: Current treatment and management

  https://www.wjgnet.com/2307-8960/full/v3/i6/484.htm

  Glucocorticoids remain the cornerstone of medical therapy in giant cell arteritis (GCA) and should be started immediately to prevent severe consequences of the disease, such as blindness. […] However, glucocorticoid therapy leads to significant toxicity in over 80% of the patients. Various steroid-sparing agents have been tried, but robust scientific evidence of their efficacy and safety is still lacking. Tocilizumab, a monoclonal IL-6 receptor blocker, has shown promising results in a number of case series and is now being tested in a multi-centre randomized controlled trial. […] The need for surgical treatment is rare and should ideally be performed in a quiescent phase of the disease. Not all patients follow the same course, but there are no valid biomarkers to assess therapy response. Monitoring of disease progress still relies on assessing clinical features and measuring inflammatory markers (C-reactive protein and erythrocyte sedimentation rate). […] Although GCA is the most common form of primary vasculitis, the optimal strategies for treatment and monitoring remain uncertain.

• #2 Giant cell arteritis: Current treatment and management

  https://www.wjgnet.com/2307-8960/full/v3/i6/484.htm

  The search for an effective disease-modifying agent for the treatment of GCA has proven elusive. […] However, given the significant burden of morbidity associated with long term glucocorticoid treatment, current BSR guidelines for the management of GCA recommend consideration of the early introduction of methotrexate or alternative immunosuppressant therapy following a relapse. […] More recently, treatment with tocilizumab, a monoclonal IL-6 receptor blocker, has shown potential in a number of case studies and case series in the treatment of patients with PMR and GCA in terms of improvement of clinical symptoms and reduction in the acute phase response. […] Despite the severe consequences of untreated GCA, such as blindness, there is no consensus on the optimal therapeutic strategies for this disease. Early initiation of glucocorticoid treatment is essential; however, the value of additional steroid-sparing synthetic or biologic agents to avoid the common glucocorticoid adverse effects or obtain quicker remission is still uncertain.

• #3 Temporal arteritis

  https://www.nhs.uk/conditions/temporal-arteritis/

  proton pump inhibitors (PPIs) to lower your risk of getting a stomach problem like indigestion or a stomach ulcer, which can be a side effect of taking prednisolone. […] bisphosphonate therapy to reduce the risk of osteoporosis when taking prednisolone. […] immunosuppressants to allow steroid medicine to be reduced and help prevent temporal arteritis coming back.

• #3 Pharmacological advances in giant cell arteritis treatment

  https://www.explorationpub.com/Journals/eaa/Article/100954

  CSs can be gradually tapered as early as the first month after the symptoms resolution, reducing CRP or ESR values by at least 50%. […] Unfortunately, as known, the use of oral corticosteroids (OCS) is linked to substantial side effects, so between 50% and 100% of patients experience at least one adverse event (AE) from OCS. […] For these reasons, the need arises to find other drugs that can replace or integrate CSs in treating GCA. […] MTX is the most studied steroid-sparing therapy in GCA is MTX therapy. […] A recent comprehensive review and meta-analysis of cohort studies found that leflunomide has CSs-sparing abilities and a favorable clinical response in GCA and Takayasu arteritis (TAK). […] Today, only tocilizumab is fully approved for GCA therapy; the other drugs are currently under investigation at different points of the study phase.

• #3 Giant Cell Arteritis (GCA) Treatment | ACTEMRA® (tocilizumab)

  https://www.actemra.com/gca.html

  ACTEMRA may increase your risk of certain cancers by changing the way your immune system works. […] If you have or are a carrier of the hepatitis B virus (a virus that affects the liver), the virus may become active while you use ACTEMRA. […] Serious allergic reactions, including death, can happen with ACTEMRA. […] While rare, Multiple Sclerosis has been diagnosed in people who take ACTEMRA. […] ACTEMRA may not be right for you.

Zobacz więcej