Materiały źródłowe

• #1 Treatment of Giant Cell Arteritis (GCA)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8999932/

  Giant cell arteritis (GCA) is the most frequent primary large-vessel vasculitis in individuals older than 50. Glucocorticoids (GCs) are considered the cornerstone of treatment. GC therapy is usually tapered over months according to clinical symptoms and inflammatory marker levels. Considering the high rate of GC-related adverse events in these older individuals, immunosuppressive treatments and biologic agents have been proposed as add-on therapies. Methotrexate was considered an alternative option, but its clinical impact was limited. Other immunosuppressants failed to demonstrate a significant favourable benefit/risk ratio. The approval of tocilizumab, an anti-interleukin 6 (IL-6) receptor inhibitor brought significant improvement. Indeed, tocilizumab had a noticeable effect on cumulative GCs dose and relapse prevention. After the improvement in pathophysiological knowledge, other targeted therapies have been proposed, with anti-IL-12/23, anti-IL-17, anti-IL-1, anti-cytotoxic T-lymphocyte antigen 4, Janus kinase inhibitors or anti-granulocyte/macrophage colony stimulating factor therapies. These therapies are currently under evaluation. Interestingly, mavrilimumab, ustekinumab and, to a lesser extent, abatacept have shown promising results in phase 2 randomised controlled trials. Despite this recent progress, the value, specific condition and optimal application of each treatment remain undecided. In this review, we discuss the scientific rationale for each treatment and the therapeutic strategy. […]

• #2 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.

• #3 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).

• #4 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.

• #5 Treatment of Giant Cell Arteritis (GCA)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8999932/

  Glucocorticoids (GCs) have been the cornerstone of GCA medical treatment since the 1950s. However, long-term use of GCs is responsible for diabetes, osteoporosis, infections, cardiovascular disease, behavioural effects or cognitive impairment. Additionally, about 86% of patients experience GC-related side effects during follow-up. Therefore, immunosuppressant (IS) therapy, including methotrexate (MTX), has been used as an adjunct therapy despite the modest effect on vasculitis control. More recently, biologic agents and, specifically, tocilizumab (TCZ) have had a major effect on preventing relapse and as a GCs-sparing treatment. Despite these alternatives, the optimal therapy for de novo or relapsing disease remains unclear, and recommendations vary among countries and over time. […] […] In patients with ischemic manifestations, methylprednisolone pulse therapy has been proposed to prevent further visual loss. Visual improvement was observed in 7% of 41 patients receiving IV methylprednisolone versus 5% of 43 patients receiving oral GCs. The treatment of visual manifestations within the first day predicted improvement in a cohort of 69 patients with GCA and visual involvement. Despite the lack of evidence for an additional effect of methylprednisolone pulse therapy, it is still the preferred option in recent recommendations for GCA with ischemic manifestations. […]

• #6 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 authors review the optimal strategies for treatment and monitoring of patients with GCA. […] Glucocorticoids remain the cornerstone of treatment in GCA since their discovery in the 1950s. They should be prescribed immediately after the diagnosis of GCA is suspected, and in most cases are able to provide complete symptomatic relief within 24-48 h. […] The EULAR guidelines recommend 1 mo of high-dose glucocorticoid therapy (prednisolone 1 mg/kg per day, maximum 60 mg/d) for induction of remission and pulsed intravenous methylprednisolone for patients with early onset of visual symptoms (dose not specified). The BSR guidelines advise prednisolone 40 to 60 mg (at least 0.75 mg/kg) daily until the resolution of symptoms and laboratory abnormalities for patients with uncomplicated GCA (without visual loss or jaw claudication); 500 mg to 1 g of intravenous methylprednisolone per day for 3 d for patients with visual loss or a history of amaurosis fugax; and at least 60 mg prednisolone daily for patients with established visual loss.

• #7 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. […] 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.

• #8 Treatment of giant cell arteritis – UpToDate

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

  We do not use lower doses of glucocorticoids (ie, prednisone <40 mg/day) as initial therapy in any patients with newly diagnosed GCA. In patients at high risk of developing glucocorticoid toxicity, we also use high doses of glucocorticoids and add a glucocorticoid-sparing agent. The approach to using a glucocorticoid-sparing agent and glucocorticoid tapering is discussed in detail below.

• #9 Giant Cell Arteritis : Johns Hopkins Vasculitis Center

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

  GCA requires treatment with prednisone, a type of corticosteroid. Typically, treatment begins with 40-60 mg of prednisone, taken by mouth each day. Most patients improve rapidly and dramatically on this dose, with improvement of most symptoms in 1-3 days. Unfortunately, if blindness has occurred as a symptom it is usually irreversible, which only emphasizes the importance of early detection and treatment. […] Because blindness from giant cell arteritis is almost irreversible, treatment with 40 to 60 mg of prednisone should be started as soon as the diagnosis is suspected. […] Patients dramatically improve within 24 to 72 hours of beginning therapy, and the ESR usually normalizes within 1 month. Thereafter, prednisone can be tapered slowly, although most patients require some prednisone for at least 9 months and often longer.

• #10 Giant Cell Arteritis

  https://rheumatology.org/patients/giant-cell-arteritis

  GCA treatment should start immediately after diagnosis to prevent vision loss. First-line treatment usually is 40-60 mg per day of prednisone, a corticosteroid. Headaches and other symptoms often ease quickly with treatment, and the sed rate drops. After about a month of high-dose corticosteroids, the dose is tapered. For most patients, prednisone dose is reduced to 5-10 mg per day over a few months. Patients often taper off prednisone completely after one to two years. GCA can return after treatment. In May 2017, tocilizumab was approved for the treatment of GCA which is given intravenous or subcutaneous injection to help decrease the need for corticosteroid. […] Side effects are more common with higher doses of corticosteroids. For example, corticosteroid treatment can cause bone loss, so your doctor may want you to get a bone density test and suggest vitamin D, calcium, or bisphosphonates to prevent osteoporosis and bone fractures. Other steroid side effects include jittery moods, weight gain, poor sleep, muscle weakness, cataracts, and skin bruising. Most steroid side effects are temporary and can be managed.

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

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

  Giant cell arteritis frequently causes headaches, scalp tenderness, jaw pain and vision problems. Untreated, it can lead to blindness. […] Prompt treatment with corticosteroid medications usually relieves symptoms of giant cell arteritis and might prevent loss of vision. You’ll likely begin to feel better within days of starting treatment. But even with treatment, relapses are common. […] If you’re diagnosed with giant cell arteritis, starting treatment as soon as possible can usually help prevent vision loss.

• #12 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. […] 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.

• #13 Giant cell arteritis (GCA) | Causes, symptoms, treatments

  https://versusarthritis.org/about-arthritis/conditions/giant-cell-arteritis-gca/

  GCA is treatable, usually with steroid tablets. But if it’s left untreated it can be very serious and cause strokes or blindness. […] While there’s currently no cure for GCA, treatment with steroid tablets is very effective and usually starts to work within a few days. Prednisolone is the most commonly used steroid tablet. […] Because there’s a risk of sight loss or a stroke if GCA isn’t treated, it’s important to start steroid treatment straight away. If your doctor suspects you have GCA, they may prescribe a high dose of steroids before the diagnosis is confirmed. […] To treat GCA, you’ll usually be given between 40 mg and 60 mg of steroid tablets every day to begin with. This dose is usually continued for three to four weeks. […] If you develop visual symptoms, or pain in your jaw or tongue when eating, you may need to go to hospital urgently to be given steroids through a drip into a vein.

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

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

  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. […] 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.

• #15 Giant cell arteritis (GCA) | Causes, symptoms, treatments

  https://versusarthritis.org/about-arthritis/conditions/giant-cell-arteritis-gca/

  Usually it takes one to three years to come off steroids altogether. For most of this time, you’ll be on a low dose. It isn’t always possible to stop taking steroids completely and some people will need to be on a low dose for a long time or for all their life. […] If the inflammation in the blood vessels returns this is called a relapse, and your steroid dose may have to be increased to deal with this. Relapse is most common within the first 18 months of treatment. […] Steroids are the first-line treatment to get GCA under control and prevent any serious complications. At present, there isn’t an alternative first-line treatment available. […] There are times when your doctor may suggest an additional medication to help you reduce the dose of steroids, this may happen if your symptoms return, otherwise known as a relapse, your symptoms do not improve despite steroid treatment, or you need steroid treatment for a long time. […] Your doctor may suggest low-strength aspirin as it helps to protect against loss of vision in GCA. You need to discuss this with your doctor to ensure it is safe for you to take aspirin.

• #16 Management of Giant Cell Arteritis and Polymyalgia Rheumatica | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0401/p2061.html

  Symptoms usually resolve quickly, often within two to three days of the initiation of the corticosteroid. Most authorities recommend continuing the high dosage of prednisone until the ESR has declined to a normal level. […] Once the ESR has normalized, a steroid taper is begun. […] Many patients have at least one recurrence of disease activity during the course of the taper. Recurrences should result in an increase in the dosage followed by a slower taper. […] Most patients with giant cell arteritis require at least two years of corticosteroid therapy. […] Patients diagnosed as having polymyalgia rheumatica should be started on 10 to 20 mg of prednisone a day. […] The response to corticosteroid therapy is usually rapid and dramatic. If a patient suspected of having polymyalgia rheumatica does not improve greatly within three to four days after the initiation of treatment, the diagnosis should be reconsidered.

• #17 Giant cell arteritis (GCA) | Causes, symptoms, treatments

  https://versusarthritis.org/about-arthritis/conditions/giant-cell-arteritis-gca/

  Usually it takes one to three years to come off steroids altogether. For most of this time, you’ll be on a low dose. It isn’t always possible to stop taking steroids completely and some people will need to be on a low dose for a long time or for all their life. […] If the inflammation in the blood vessels returns this is called a relapse, and your steroid dose may have to be increased to deal with this. Relapse is most common within the first 18 months of treatment. […] Steroids are the first-line treatment to get GCA under control and prevent any serious complications. At present, there isn’t an alternative first-line treatment available. […] There are times when your doctor may suggest an additional medication to help you reduce the dose of steroids, this may happen if your symptoms return, otherwise known as a relapse, your symptoms do not improve despite steroid treatment, or you need steroid treatment for a long time. […] Your doctor may suggest low-strength aspirin as it helps to protect against loss of vision in GCA. You need to discuss this with your doctor to ensure it is safe for you to take aspirin.

• #18 Giant Cell Arteritis – EyeWiki

  https://eyewiki.org/Giant_Cell_Arteritis

  There is no consensus on how frequently patients should be seen after starting treatment. […] Once the decision is made to taper the corticosteroids, it is usually decreased at a rate of 5-10 mg per month until a dose of 10-15 mg per day is reached, and then the taper is decreased by 1-5 mg per month. […] In general, most cases of GCA relapse have been shown to occur at prednisone doses below 20mg/day especially during the first year of treatment.

• #19 Management of Giant Cell Arteritis and Polymyalgia Rheumatica | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0401/p2061.html

  Symptoms usually resolve quickly, often within two to three days of the initiation of the corticosteroid. Most authorities recommend continuing the high dosage of prednisone until the ESR has declined to a normal level. […] Once the ESR has normalized, a steroid taper is begun. […] Many patients have at least one recurrence of disease activity during the course of the taper. Recurrences should result in an increase in the dosage followed by a slower taper. […] Most patients with giant cell arteritis require at least two years of corticosteroid therapy. […] Patients diagnosed as having polymyalgia rheumatica should be started on 10 to 20 mg of prednisone a day. […] The response to corticosteroid therapy is usually rapid and dramatic. If a patient suspected of having polymyalgia rheumatica does not improve greatly within three to four days after the initiation of treatment, the diagnosis should be reconsidered.

• #20 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.

• #21 Treatment of Giant Cell Arteritis (GCA)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8999932/

  Glucocorticoids (GCs) have been the cornerstone of GCA medical treatment since the 1950s. However, long-term use of GCs is responsible for diabetes, osteoporosis, infections, cardiovascular disease, behavioural effects or cognitive impairment. Additionally, about 86% of patients experience GC-related side effects during follow-up. Therefore, immunosuppressant (IS) therapy, including methotrexate (MTX), has been used as an adjunct therapy despite the modest effect on vasculitis control. More recently, biologic agents and, specifically, tocilizumab (TCZ) have had a major effect on preventing relapse and as a GCs-sparing treatment. Despite these alternatives, the optimal therapy for de novo or relapsing disease remains unclear, and recommendations vary among countries and over time. […] […] In patients with ischemic manifestations, methylprednisolone pulse therapy has been proposed to prevent further visual loss. Visual improvement was observed in 7% of 41 patients receiving IV methylprednisolone versus 5% of 43 patients receiving oral GCs. The treatment of visual manifestations within the first day predicted improvement in a cohort of 69 patients with GCA and visual involvement. Despite the lack of evidence for an additional effect of methylprednisolone pulse therapy, it is still the preferred option in recent recommendations for GCA with ischemic manifestations. […]

• #22 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 authors review the optimal strategies for treatment and monitoring of patients with GCA. […] Glucocorticoids remain the cornerstone of treatment in GCA since their discovery in the 1950s. They should be prescribed immediately after the diagnosis of GCA is suspected, and in most cases are able to provide complete symptomatic relief within 24-48 h. […] The EULAR guidelines recommend 1 mo of high-dose glucocorticoid therapy (prednisolone 1 mg/kg per day, maximum 60 mg/d) for induction of remission and pulsed intravenous methylprednisolone for patients with early onset of visual symptoms (dose not specified). The BSR guidelines advise prednisolone 40 to 60 mg (at least 0.75 mg/kg) daily until the resolution of symptoms and laboratory abnormalities for patients with uncomplicated GCA (without visual loss or jaw claudication); 500 mg to 1 g of intravenous methylprednisolone per day for 3 d for patients with visual loss or a history of amaurosis fugax; and at least 60 mg prednisolone daily for patients with established visual loss.

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

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

  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. […] 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.

• #24 Treatment of Giant Cell Arteritis (GCA)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8999932/

  Since the early 1990s, interleukin 6 (IL-6) levels have been found to be associated with disease activity in GCA. The potential interest of TCZ, a monoclonal antibody targeting the -chain of the IL-6 receptor has emerged since 2010. After several case series, two RCTs confirmed that TCZ could have a major impact on relapse prevention or as a GCs-sparing agent. This striking improvement was confirmed and supported in the GIACTA study, a large phase 3 trial including 251 patients. More than half of patients receiving TCZ subcutaneously every week or every other week showed sustained remission as compared with those receiving GCs only tapered over 26 or 52 weeks. […] […] Treatment with high-dose GC therapy allows for clinical and biological remission in patients with GCA. There are no evidence-based data to support the use of a higher initial dose of GCs for patients with specific manifestations. The improvement in visual manifestations seems related to the delay between symptoms and treatment rather than the GCs dose. In this context, high-dose IV methylprednisolone is considered the best treatment for patients with visual manifestations, on an expert opinion basis. […]

• #25 Giant Cell Arteritis (Temporal Arteritis): Signs & Treatment

  https://my.clevelandclinic.org/health/diseases/temporal-arteritis-giant-cell-arteritis

  Giant cell arteritis treatment should begin immediately to prevent vision loss. The primary treatment is a glucocorticoid, usually prednisone. You’ll likely start taking it at a dose of 40 mg to 60 mg per day (by mouth), and your provider will gradually reduce your dosage. If you already have vision loss or other vision symptoms, your provider may treat you with a high dose of glucocorticoids through a catheter in your vein (IV). […] Since glucocorticoids can cause serious side effects, your provider will monitor your response to these medications closely. Because glucocorticoids suppress your immune system, side effects can include more frequent and more severe infections. They can also make your bones thinner, which raises your risk of fractures. […] In 2017, the U.S. Food and Drug Administration approved a new biologic medication called tocilizumab (Actemra) for the treatment of GCA. This medication is given as an injection (under your skin) or through an IV (in your vein). It can help decrease your need for glucocorticoids. Tocilizumab is associated with other side effects that your provider will discuss with you.

• #26 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. […] 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.

• #27 Giant Cell Arteritis (Temporal Arteritis) | Doctor

  https://patient.info/doctor/giant-cell-arteritis-pro

  Flare-ups and relapses usually respond to corticosteroid increases to the level at which symptoms previously were controlled. Protracted courses of therapy are often necessary. […] Glucocorticoid therapy leads to significant toxicity in over 80% of the patients. Osteoporosis prophylaxis is required for patients on long-term steroid treatment. […] Tocilizumab (a monoclonal antibody against the interleukin-6 receptor) is an effective glucocorticoid-sparing therapy, demonstrating sustained glucocorticoid-free remission in 56% of patients receiving weekly tocilizumab compared with 18% of patients receiving a 52-week prednisone taper. […] Its use has expanded, however, and is used more widely in the initial treatment of giant cell arteritis (alongside corticosteroids), especially in patients who are at a high risk of glucocorticoid toxicity. […] Methotrexate is a potential alternative to tocilizumab as a glucocorticoid-sparing therapy to reduce relapse risk.

• #28 Giant Cell Arteritis Treatment Options | ACTEMRA® (tocilizumab)

  https://www.actemra.com/gca/disease-info/treatment-options.html

  GCA can cause serious complications, which is why its important to treat it right away. When GCA is diagnosed and treated early, youre more likely to see better results. […] Treatment for GCA usually starts with high doses of steroids to immediately control inflammation. If the inflammation becomes less serious, the steroid dose can be lowered. While steroids are useful for treating GCA, long-term use can result in a high total dose of steroids. This high total dose may cause serious side effects. An example of a steroid you may have heard of is called prednisone. […] ACTEMRA is used: To treat adults with giant cell arteritis (GCA). […] ACTEMRA changes the way your immune system works. This can make you more likely to get infections or make any current infection worse. […] 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. Changes in blood test results may cause your healthcare provider to stop your ACTEMRA treatment for a time or change your dose.

• #29 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. […] 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. […] ACTEMRA may increase your risk of certain cancers by changing the way your immune system works.

• #30 Giant cell arteritis // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/giant-cell-arteritis

  Some symptoms, particularly headaches, may return during this tapering period. This is the point at which many people also develop symptoms of polymyalgia rheumatica. Such flares can usually be treated with slight increases in the corticosteroid dose. Your doctor might also suggest an immune-suppressing drug called methotrexate (Trexall). […] Corticosteroids can lead to serious side effects, such as osteoporosis, high blood pressure and muscle weakness. To counter potential side effects, your doctor is likely to monitor your bone density and might prescribe calcium and vitamin D supplements or other medications to help prevent bone loss. […] The Food and Drug Administration recently approved tocilizumab (Actemra) to treat giant cell arteritis. It’s given as an injection under your skin. Side effects include making you more prone to infections. More research is needed.

• #31 Giant Cell Arteritis Treatment Options | ACTEMRA® (tocilizumab)

  https://www.actemra.com/gca/disease-info/treatment-options.html

  GCA can cause serious complications, which is why its important to treat it right away. When GCA is diagnosed and treated early, youre more likely to see better results. […] Treatment for GCA usually starts with high doses of steroids to immediately control inflammation. If the inflammation becomes less serious, the steroid dose can be lowered. While steroids are useful for treating GCA, long-term use can result in a high total dose of steroids. This high total dose may cause serious side effects. An example of a steroid you may have heard of is called prednisone. […] ACTEMRA is used: To treat adults with giant cell arteritis (GCA). […] ACTEMRA changes the way your immune system works. This can make you more likely to get infections or make any current infection worse. […] 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. Changes in blood test results may cause your healthcare provider to stop your ACTEMRA treatment for a time or change your dose.

• #32 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).

• #33 Treatment of giant cell arteritis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31034796/

  Giant cell arteritis (GCA) is the most common form of vasculitis in adults. […] Prednisone/prednisolone at a dose of 40-60 mg/day is the cornerstone therapy in GCA. Glucocorticoids lead to rapid improvement of symptoms and may reduce the risk of irreversible visual loss. […] Therefore, additional therapies are required in relapsing GCA or when a rapid reduction of glucocorticoids is needed. The most widely used conventional immunosuppressive drug is methotrexate. Adjunctive treatment with methotrexate may decrease the risk of relapses and reduce glucocorticoid exposure. […] Among them, the most frequently used is the recombinant humanized anti-IL-6 receptor antibody tocilizumab. It improves clinical symptoms, reduce the cumulative prednisone dose and the frequency of relapses in GCA patients. However, anti-tumor necrosis factor- therapy is not useful in GCA. Promising results on other biologic agents, such as abatacept, ustekinumab or anakinra, require further confirmatory studies.

• #34 Treatment of Giant Cell Arteritis (GCA)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8999932/

  Despite improvement in the side effects prophylaxes, long-term use of GCs is associated with osteoporosis, infection or diabetes, which are a major concern in older individuals. Therefore, IS therapy has been evaluated for reducing patient exposure to GCs, relapse rate, and less frequently, remission induction rate. Three RCTs evaluated MTX (7.5-20 mg/week) as an add-on therapy for newly diagnosed disease. These trials found no significant GCs-sparing effect or reduction in relapse rate despite limits. Following these conflicting results, an individual patient data analysis suggested hazard ratios for a first and second relapse. The real impact of MTX in real life is still debated, and a large multicentric RCT evaluating MTX versus TCZ is attempting to answer this delicate question. […]

• #35 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 and EULAR guidelines for the management of large vessel vasculitis recommend that an immunosuppressant agent should be considered for use in large vessel vasculitis as adjunctive therapy. […] Of the limited available evidence, methotrexate may be of benefit in the management of GCA. […] 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.

• #36 Treatment of Giant Cell Arteritis (GCA)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8999932/

  Despite improvement in the side effects prophylaxes, long-term use of GCs is associated with osteoporosis, infection or diabetes, which are a major concern in older individuals. Therefore, IS therapy has been evaluated for reducing patient exposure to GCs, relapse rate, and less frequently, remission induction rate. Three RCTs evaluated MTX (7.5-20 mg/week) as an add-on therapy for newly diagnosed disease. These trials found no significant GCs-sparing effect or reduction in relapse rate despite limits. Following these conflicting results, an individual patient data analysis suggested hazard ratios for a first and second relapse. The real impact of MTX in real life is still debated, and a large multicentric RCT evaluating MTX versus TCZ is attempting to answer this delicate question. […]

• #37 Treatment of Giant Cell Arteritis (GCA)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8999932/

  In an RCT of relapsing GCA in clinical remission after GC therapy, 31 patients received azathioprine (AZA) as an add-on therapy or a placebo. After a 52-week follow-up, patients receiving AZA received a reduced dose of GCs. Despite the positive result, the modest clinical impact has not changed medical practice, and AZA is rarely used as an additional therapy. Dapsone was found to be effective in addition to GC as a first-line therapy or as a GCs-sparing agent in relapsing GCA. However, patients experienced numerous side effects, including skin rash or agranulocytosis, and it is no longer considered a safe alternative. […] […] Immunohistology studies have detected tumour necrosis factor (TNF-) in inflamed arteries. From this observation and case reports, several RCTs of TNF- versus a placebo evaluated the clinical value of targeting TNF- or its receptor. Despite the strong rationale, all three RCTs had negative findings and failed to demonstrate a benefit for remission induction, GC therapy withdrawal, relapse rate, or as a GCs-sparing therapy. The efficacy and safety of blocking T-cell activation with abatacept was evaluated in an RCT. Despite an increased relapse-free survival with abatacept, the phase 3 RCT was withdrawn, although abatacept is still being evaluated versus placebo in another RCT for remission induction at year 1. […]

• #38 Giant Cell Arteritis (Temporal Arteritis) Medication: Corticosteroids, Interleukin Inhibitors, Immunosuppressant Agents, Antiplatelet Agents

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

  Interleukin-6 receptor antagonist. Inhibits IL-6-mediated signaling that results in proinflammatory cytokines. It is indicated for treatment of GCA in adults. […] These agents inhibit key factors of the immune system. They may have anti-inflammatory properties in GCA and result in steroid sparing in relatively resistant cases. […] Azathioprine is reserved for patients experiencing steroid failure or unacceptable adverse effects from prolonged steroid use; it can be used for its steroid-sparing effects to allow lowering of the steroid dose. […] Low-dose aspirin decreases the rates of visual loss and strokes in patients with giant cell arteritis. […] Aspirin may be used in a low dose to inhibit platelet aggregation and improve the complications of venous stasis and thrombosis. It reduces the likelihood of myocardial infarction and the risk of stroke.

• #39 Pharmacological advances in giant cell arteritis treatment

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

  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. […] So far, only tocilizumab, an interleukin 6 receptor (IL-6R) inhibitor, 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.

• #40 Treatment of Giant Cell Arteritis (GCA)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8999932/

  In an RCT of relapsing GCA in clinical remission after GC therapy, 31 patients received azathioprine (AZA) as an add-on therapy or a placebo. After a 52-week follow-up, patients receiving AZA received a reduced dose of GCs. Despite the positive result, the modest clinical impact has not changed medical practice, and AZA is rarely used as an additional therapy. Dapsone was found to be effective in addition to GC as a first-line therapy or as a GCs-sparing agent in relapsing GCA. However, patients experienced numerous side effects, including skin rash or agranulocytosis, and it is no longer considered a safe alternative. […] […] Immunohistology studies have detected tumour necrosis factor (TNF-) in inflamed arteries. From this observation and case reports, several RCTs of TNF- versus a placebo evaluated the clinical value of targeting TNF- or its receptor. Despite the strong rationale, all three RCTs had negative findings and failed to demonstrate a benefit for remission induction, GC therapy withdrawal, relapse rate, or as a GCs-sparing therapy. The efficacy and safety of blocking T-cell activation with abatacept was evaluated in an RCT. Despite an increased relapse-free survival with abatacept, the phase 3 RCT was withdrawn, although abatacept is still being evaluated versus placebo in another RCT for remission induction at year 1. […]

• #41 Giant Cell Arteritis: Current Advances in Pathogenesis and Treatment | IntechOpen

  https://www.intechopen.com/chapters/70933

  Ustekinumab may be effective for the treatment of GCA. […] Abatacept is a fully human fusion protein that binds to CD80/CD86 on antigen-presenting cells preventing these molecules from binding to their ligand, CD28, and is moderately effective in the treatment of GCA. […] Anti-TNF agents have been tested and yielded disappointing results, showing no efficacy in reducing GC dose or relapse rates in GCA. […] Patients with GCA are elderly and frequently have multiple comorbid conditions that can be worsened by the use of GC and immunosuppressants. […] Low-dose aspirin (80-100 mg/day) should be prescribed for prevention of cardiovascular events, which represent the main cause of death in this population.

• #42 Giant Cell Arteritis: Symptoms & Treatment | Massachusetts General Hospital

  https://www.massgeneral.org/medicine/rheumatology/treatments-and-services/giant-cell-arteritis

  This phase 3 clinical trial examines whether 12 months of secukinumab, in combination with 6 months of prednisone, is effective in keeping Giant Cell Arteritis in remission. […] Tocilizumab plus a short prednisone taper for the treatment of giant cell arteritis. […] Mavrilimumab for the treatment of Giant Cell Arteritis. […] Ustekinumab for the treatment of Giant Cell Arteritis. […] Sarilumab for the treatment of Giant Cell Arteritis. […] Sarilumab for the treatment of Polymyalgia Rheumatica. […] Sirukumab for the treatment of Giant Cell Arteritis.

• #43 Unveiling New Avenues in Giant-Cell Arteritis Treatment

  https://www.delveinsight.com/blog/giant-cell-arteritis-treatment-therapies

  Productive pharmacologic options for managing the most prevalent and most disabling phases of giant-cell arteritis are minimal. Treatments that work in this disorder are scarce; therefore, new giant-cell arteritis treatments are desperately needed. Some companies like Novartis (COSENTYX; secukinumab), AbbVie (RINVOQ; upadacitinib), and JJ/MorphoSys AG (TREMFYA; guselkumab) have initiated clinical trials that investigate new giant-cell arteritis treatment options. […] RINVOQ (upadacitinib) is an oral medication that selectively and reversibly inhibits Janus kinase (JAK), a crucial component in the immune signaling pathway, particularly the JAK-STAT pathway utilized by proinflammatory cytokines to communicate with the cell nucleus. […] Secukinumab, a monoclonal antibody of the human IgG1 type, specifically attaches to the interleukin-17A (IL-17A) cytokine, preventing its interaction with the IL-17 receptor.

• #44 Treatment of Giant Cell Arteritis (GCA)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8999932/

  In an RCT of relapsing GCA in clinical remission after GC therapy, 31 patients received azathioprine (AZA) as an add-on therapy or a placebo. After a 52-week follow-up, patients receiving AZA received a reduced dose of GCs. Despite the positive result, the modest clinical impact has not changed medical practice, and AZA is rarely used as an additional therapy. Dapsone was found to be effective in addition to GC as a first-line therapy or as a GCs-sparing agent in relapsing GCA. However, patients experienced numerous side effects, including skin rash or agranulocytosis, and it is no longer considered a safe alternative. […] […] Immunohistology studies have detected tumour necrosis factor (TNF-) in inflamed arteries. From this observation and case reports, several RCTs of TNF- versus a placebo evaluated the clinical value of targeting TNF- or its receptor. Despite the strong rationale, all three RCTs had negative findings and failed to demonstrate a benefit for remission induction, GC therapy withdrawal, relapse rate, or as a GCs-sparing therapy. The efficacy and safety of blocking T-cell activation with abatacept was evaluated in an RCT. Despite an increased relapse-free survival with abatacept, the phase 3 RCT was withdrawn, although abatacept is still being evaluated versus placebo in another RCT for remission induction at year 1. […]

• #45 Biologic Therapies for Giant Cell Arteritis | BTT

  https://www.dovepress.com/biologic-therapies-for-giant-cell-arteritis-peer-reviewed-fulltext-article-BTT

  Currently, glucocorticoids remain the anchor treatment for inducing remission and biologics to date have been proposed as adjunctive glucocorticoid sparing agents. […] The best evidence for the role of IL-6 inhibition in GCA comes from the Giant-Cell Arteritis Actemra (GiACTA) trial which investigated the potential efficacy of tocilizumab. […] The BSR and EULAR guidelines both recommend the use of tocilizumab in patients with GCA who have relapsing disease or who have high baseline risk for glucocorticoid-related adverse events. […] We make the tentative recommendation that GCA cases refractory to tocilizumab may trial ustekinumab or abatacept. […] JAK inhibitors and IL-1 inhibitors are currently in trials for GCA which may reshape best guidance on GCA treatment over the next decade.

• #46 Treatment of Giant Cell Arteritis (GCA)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8999932/

  Giant cell arteritis (GCA) is the most frequent primary large-vessel vasculitis in individuals older than 50. Glucocorticoids (GCs) are considered the cornerstone of treatment. GC therapy is usually tapered over months according to clinical symptoms and inflammatory marker levels. Considering the high rate of GC-related adverse events in these older individuals, immunosuppressive treatments and biologic agents have been proposed as add-on therapies. Methotrexate was considered an alternative option, but its clinical impact was limited. Other immunosuppressants failed to demonstrate a significant favourable benefit/risk ratio. The approval of tocilizumab, an anti-interleukin 6 (IL-6) receptor inhibitor brought significant improvement. Indeed, tocilizumab had a noticeable effect on cumulative GCs dose and relapse prevention. After the improvement in pathophysiological knowledge, other targeted therapies have been proposed, with anti-IL-12/23, anti-IL-17, anti-IL-1, anti-cytotoxic T-lymphocyte antigen 4, Janus kinase inhibitors or anti-granulocyte/macrophage colony stimulating factor therapies. These therapies are currently under evaluation. Interestingly, mavrilimumab, ustekinumab and, to a lesser extent, abatacept have shown promising results in phase 2 randomised controlled trials. Despite this recent progress, the value, specific condition and optimal application of each treatment remain undecided. In this review, we discuss the scientific rationale for each treatment and the therapeutic strategy. […]

• #47 Giant Cell Arteritis: Current Advances in Pathogenesis and Treatment | IntechOpen

  https://www.intechopen.com/chapters/70933

  Ustekinumab may be effective for the treatment of GCA. […] Abatacept is a fully human fusion protein that binds to CD80/CD86 on antigen-presenting cells preventing these molecules from binding to their ligand, CD28, and is moderately effective in the treatment of GCA. […] Anti-TNF agents have been tested and yielded disappointing results, showing no efficacy in reducing GC dose or relapse rates in GCA. […] Patients with GCA are elderly and frequently have multiple comorbid conditions that can be worsened by the use of GC and immunosuppressants. […] Low-dose aspirin (80-100 mg/day) should be prescribed for prevention of cardiovascular events, which represent the main cause of death in this population.

• #48 Pharmacological advances in giant cell arteritis treatment

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

  Mavrilimumab significantly reduced exacerbations versus placebo, and durable remission occurred in 83.2% of patients taking mavrilimumab while only 49.9% of patients taking placebo. […] Anakinra appears to have a steroid sparing effect, with good tolerance even over an extended period, 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. […] Immense progress has been made in the therapeutic approach to giant cells therapy due to the novel findings on the pathogenetic pathways. […] Hence following the wave of the steroid-sparing effect of the other biological treatment, tocilizumab has been used firstly as an anchor drug with a well-recognized steroid-sparing effect.

• #49 Clinical Trial to Test Potential New Therapy for Giant Cell Arteritis

  https://news.hss.edu/clinical-trial-to-test-potential-new-therapy-for-giant-cell-arteritis/

  Clinical Trial to Test Potential New Therapy for Giant Cell Arteritis […] An international, multicenter phase II clinical trial is evaluating the efficacy and safety of mavrilimumab co-administered with a 26-week corticosteroid taper in patients with giant cell arteritis (GCA). […] For decades, the mainstay of treatment for GCA has been high doses of prednisone and other systemic glucocorticoid steroids, which work quickly to reduce inflammation but come with a host of potential side effects and toxicities. […] One drug, tocilizumab, which was approved for GCA in 2017, has been effective in limiting the amount of steroids that some patients need, but it is not appropriate for everyone. […] We still need to find other treatment strategies that can adequately control the inflammation while minimizing the amount of steroids that we expose patients to, said Dr. Lally. […] Mavrilimumab is a human monoclonal antibody that binds to the granulocyte macrophage colony-stimulating factor (GM-CSF) receptor alpha, inhibiting the GM-CSF signaling. […] Data in preclinical models suggest that blocking this chemical may stop the proliferation of inflammatory cells in GCA. […] The primary objective is sustained remission at week 26, said Dr. Lally. Endpoints include time to flare, sustained remission, and cumulative steroid doses. The goal is to see if patients can be on clinical remission, off of steroids, within 26 weeks. […] Mavrilimumab has been previously studied in over 500 patients with rheumatoid arthritis. Dr. Lally will review the safety profile of mavrilimumab with patients who qualify for this study. Patients will be followed very closely for any potential side effects. […] According to Robert F. Spiera, MD, director of the Vasculitis and Scleroderma Program at HSS, there is a heterogeneity to large vessel vasculitis. This trial targets a mechanism that we would expect to be relevant to these disorders, he said. We continue to strive to help develop better therapies and are excited to have this trial available to our patients.

• #50 Advances in the treatment of polymyalgia rheumatica and giant cell arteritis | Nature Reviews Rheumatology

  https://www.nature.com/articles/s41584-023-01069-2

  Research published in 2023 has demonstrated the efficacy of sarilumab for IL-6 blockade in polymyalgia rheumatica and of secukinumab for IL-17 blockade in giant cell arteritis (GCA). […] Inhibition of IL-17 with secukinumab is an emerging therapeutic option for giant cell arteritis (GCA) that is currently being explored in a phase 3 study after promising results of the phase 2 TitAIN trial, in which 70% of secukinumab-treated patients achieved the primary outcome of sustained remission at week 28, compared with 20% of the placebo group. […] In an ex vivo model of GCA using temporal artery specimens from patients with GCA, human monocyte-derived suppressive cells decreased the concentrations of proinflammatory cytokines and downregulated the expression of genes associated with inflammation and vascular remodeling, which suggests that these cells could have therapeutic value in GCA.

• #51 Unveiling New Avenues in Giant-Cell Arteritis Treatment

  https://www.delveinsight.com/blog/giant-cell-arteritis-treatment-therapies

  Productive pharmacologic options for managing the most prevalent and most disabling phases of giant-cell arteritis are minimal. Treatments that work in this disorder are scarce; therefore, new giant-cell arteritis treatments are desperately needed. Some companies like Novartis (COSENTYX; secukinumab), AbbVie (RINVOQ; upadacitinib), and JJ/MorphoSys AG (TREMFYA; guselkumab) have initiated clinical trials that investigate new giant-cell arteritis treatment options. […] RINVOQ (upadacitinib) is an oral medication that selectively and reversibly inhibits Janus kinase (JAK), a crucial component in the immune signaling pathway, particularly the JAK-STAT pathway utilized by proinflammatory cytokines to communicate with the cell nucleus. […] Secukinumab, a monoclonal antibody of the human IgG1 type, specifically attaches to the interleukin-17A (IL-17A) cytokine, preventing its interaction with the IL-17 receptor.

• #52 Giant Cell Arteritis (GCA) Treatment Goals | RINVOQ®

  https://www.rinvoq.com/giant-cell-arteritis/treatment

  GCA can begin suddenly and requires immediate steroid treatment. […] Steroids are an effective early treatment option, but they may cause serious side effects, especially when used over long periods of timeeven at low doses. For the long term, other non-steroid treatments are available to help people living with GCA reach remission. […] People diagnosed with GCA are usually prescribed steroids to reduce inflammation, bring symptoms under control, and prevent serious health complications. […] To minimize steroid side effects and keep inflammation under control, long-term treatment plans for GCA include steroid tapering, which is the process of decreasing the dose over time. […] Talk to your doctor about treatment options that allow for you to gradually get off steroids, and discuss the benefits and risks of treatment. […] The best way to manage GCA is to partner with your healthcare providerspecifically, a rheumatologist. Together, you can develop an effective treatment plan. […] RINVOQ is a prescription medicine used to treat adults with giant cell arteritis (GCA).

• #53 Pharmacological advances in giant cell arteritis treatment

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

  Mavrilimumab significantly reduced exacerbations versus placebo, and durable remission occurred in 83.2% of patients taking mavrilimumab while only 49.9% of patients taking placebo. […] Anakinra appears to have a steroid sparing effect, with good tolerance even over an extended period, 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. […] Immense progress has been made in the therapeutic approach to giant cells therapy due to the novel findings on the pathogenetic pathways. […] Hence following the wave of the steroid-sparing effect of the other biological treatment, tocilizumab has been used firstly as an anchor drug with a well-recognized steroid-sparing effect.

• #54 Giant Cell Arteritis – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/giant-cell-arteritis/

  Methotrexate has been used to treat refractory giant cell arteritis as a steroid-sparing drug. […] Anakinra, an anti-IL-1 agent, was shown to be more effective than standard therapies in a study that assessed 3 patients with refractory GCA. […] Aspirin has been linked to a lower rate of loss of vision and strokes in patients with GCA and has been used as adjuvant therapy.

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

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

  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. […] 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.

• #56 Giant cell arteritis (GCA) | Causes, symptoms, treatments

  https://versusarthritis.org/about-arthritis/conditions/giant-cell-arteritis-gca/

  Usually it takes one to three years to come off steroids altogether. For most of this time, you’ll be on a low dose. It isn’t always possible to stop taking steroids completely and some people will need to be on a low dose for a long time or for all their life. […] If the inflammation in the blood vessels returns this is called a relapse, and your steroid dose may have to be increased to deal with this. Relapse is most common within the first 18 months of treatment. […] Steroids are the first-line treatment to get GCA under control and prevent any serious complications. At present, there isn’t an alternative first-line treatment available. […] There are times when your doctor may suggest an additional medication to help you reduce the dose of steroids, this may happen if your symptoms return, otherwise known as a relapse, your symptoms do not improve despite steroid treatment, or you need steroid treatment for a long time. […] Your doctor may suggest low-strength aspirin as it helps to protect against loss of vision in GCA. You need to discuss this with your doctor to ensure it is safe for you to take aspirin.

• #57 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. […] 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.

• #58 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.

• #59 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.

• #60

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

  The initial dose of prednisone should be maintained for four weeks, or longer if symptoms and laboratory abnormalities remain. […] Aspirin, 100 mg, daily, should be considered for patients without contraindications as there is some evidence that it decreases the rate of visual loss and other cerebrovascular complications. […] Vitamin D supplements and advice to maintain adequate calcium intake should be given to all patients in order to limit the adverse effects of long-term prednisone treatment. […] A follow-up consultation should be scheduled to ensure there are no signs or symptoms of relapse of giant cell arteritis, and to monitor the adverse effects of corticosteroid treatment. […] Relapse of symptoms is relatively common in people with giant cell arteritis, particularly once the dose of prednisone is low, e.g. under 15 mg per day. Relapse should be suspected in patients with a return of symptoms, ischaemic complications, unexplained fever or polymyalgic symptoms. […] The majority of patients respond rapidly to the initial treatment with prednisone, and visual loss in treated patients (without preceding visual symptoms) is rare, generally under 1%.

• #61 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.

• #62 Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica | Annals of the Rheumatic Diseases

  https://ard.bmj.com/content/83/1/48

  TCZ has been approved for treatment in GCA following the phase III study mentioned above, which demonstrated higher remission rates and better GC sparing than placebo. […] The treat-to-target (T2T) concept includes the definition of a specific treatment target, regular monitoring of the progress of therapy with respect to the treatment target and, if necessary, adjustment of therapy to achieve the lowest possible disease activity or remission. […] These T2T recommendations are intended to advise primary, secondary and tertiary care physicians (including general practitioners, rheumatologists, ophthalmologists, neurologists, geriatricians as well as specialists in internal or vascular medicine, radiology and vascular surgery), health professionals in rheumatology, pharmacists, patient organisations, payers, hospital managers and trial investigators.

• #63 Step forward towards treat-to-target management of giant cell arteritis: patients stratification aiming to targeted remission – updated guidelines | Egyptian Rheumatology and Rehabilitation | Full Text

  https://erar.springeropen.com/articles/10.1186/s43166-024-00237-w

  The aim of this work is to develop guidelines for health care professionals in the giant cell arteritis diagnosis and management, based on patients stratification and targeted outcome measures. […] Patient stratification facilitate the initiation of an appropriate management approach for patients with giant cell arteritis aiming at achieving targeted disease remission state and prevention of visual loss and/or development of ischaemic events. Treat to Target approach is a new concept in giant cell arteritis management which aims to provide tight control to achieve and maintain disease remission. This work defined the treatment targets in relation to the disease stage. […] GCA management should target control of the disease symptoms, avert any damage attributed to GCA, consider any relevant comorbidities and minimize treatment associated side effects. In the meantime, GCA management should aim to maximise the individual patients health-related quality of life.

• #64 Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica | Annals of the Rheumatic Diseases

  https://ard.bmj.com/content/83/1/48

  A total of five overarching principles and six specific recommendations were formulated. […] The treatment target of GCA and PMR should be remission; remission is the absence of clinical symptoms and systemic inflammation. […] Treatment of GCA should also aim to prevent tissue ischemia and vascular damage. […] Treatment selection in GCA and PMR should be based on disease severity and activity, presence of relevant comorbidities and potential predictors of outcome; treatment should be modified as needed during follow-up. […] Once remission is reached, it should be maintained with the minimal effective dose of medication; drug-free remission may be achieved in a proportion of patients. […] Disease activity in GCA and PMR should be monitored regularly, as frequently as every 14 weeks until remission has been achieved, and at longer monitoring intervals (eg, between 3 and 6 months) in patients in stable remission on therapy; monitoring of patients off therapy should be discussed on an individual basis.

• #65 Step forward towards treat-to-target management of giant cell arteritis: patients stratification aiming to targeted remission – updated guidelines | Egyptian Rheumatology and Rehabilitation | Full Text

  https://erar.springeropen.com/articles/10.1186/s43166-024-00237-w

  GCA treatment strategy should be guided by disease stratification. This can be achieved through using clinical, biomarkers, histology, and imaging parameters as well as the presence of associated comorbidities and possible medical therapy associated complications. […] Treatment can be splitted into: Induction and maintenance phases. […] Immediate glucocorticoid prescription is recommended when GCA is confirmed or strongly suspected. […] The initial oral GC dose is oral prednisolone 40-60 mg once daily. […] If there are cranial ischaemic symptoms, e.g. visual disturbance, amaurosis fugax, vision loss, and stroke, 250-500mg IV methylprednisolone is recommended as induction dose for three days followed by oral GC course starting at a dose of 60mg/day. […] A regimen for glucocorticoids tapering should start once the disease is controlled.

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

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

  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. […] The upfront use of steroid-sparing therapies should be individualized based on the patients clinical phenotype and risk of glucocorticoid toxicity. Patients with evidence of large vessel disease, or those with pre-existing osteoporosis, glaucoma, diabetes, or certain psychiatric comorbidities are often treated upfront with a steroid-sparing agent. This decision should ultimately be deferred to the patients rheumatologist. Steroid-sparing agents are recommended in all patients who relapse on glucocorticoid monotherapy.

• #67 Step forward towards treat-to-target management of giant cell arteritis: patients stratification aiming to targeted remission – updated guidelines | Egyptian Rheumatology and Rehabilitation | Full Text

  https://erar.springeropen.com/articles/10.1186/s43166-024-00237-w

  GCA treatment strategy should be guided by disease stratification. This can be achieved through using clinical, biomarkers, histology, and imaging parameters as well as the presence of associated comorbidities and possible medical therapy associated complications. […] Treatment can be splitted into: Induction and maintenance phases. […] Immediate glucocorticoid prescription is recommended when GCA is confirmed or strongly suspected. […] The initial oral GC dose is oral prednisolone 40-60 mg once daily. […] If there are cranial ischaemic symptoms, e.g. visual disturbance, amaurosis fugax, vision loss, and stroke, 250-500mg IV methylprednisolone is recommended as induction dose for three days followed by oral GC course starting at a dose of 60mg/day. […] A regimen for glucocorticoids tapering should start once the disease is controlled.

• #68 Treatment of Giant Cell Arteritis (GCA)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8999932/

  Major efforts have been made recently to develop GC-reduced therapeutic strategies in GCA. This work questions the value of GCs in the disease. Is it the feared treatment to avoid in this frail population? We acknowledge that a short GC therapy has a rapid effect on vasculitis control. Better defining which patients might benefit from alternative therapy is crucial to appropriately using each treatment within a safe and cost-effective strategy. TCZ has the strongest evidence as a GC add-on therapy in patients with newly diagnosed or relapsing GCA. In the future, head-to-head comparisons of biological therapies might be required to build an efficient therapeutic strategy in these patients. Available GC add-on therapies have a steroid sparing effect and reduce relapse occurrence but fail to cure GCA, warranting further research.

• #69 Biologic Therapies for Giant Cell Arteritis | BTT

  https://www.dovepress.com/biologic-therapies-for-giant-cell-arteritis-peer-reviewed-fulltext-article-BTT

  Currently, glucocorticoids remain the anchor treatment for inducing remission and biologics to date have been proposed as adjunctive glucocorticoid sparing agents. […] The best evidence for the role of IL-6 inhibition in GCA comes from the Giant-Cell Arteritis Actemra (GiACTA) trial which investigated the potential efficacy of tocilizumab. […] The BSR and EULAR guidelines both recommend the use of tocilizumab in patients with GCA who have relapsing disease or who have high baseline risk for glucocorticoid-related adverse events. […] We make the tentative recommendation that GCA cases refractory to tocilizumab may trial ustekinumab or abatacept. […] JAK inhibitors and IL-1 inhibitors are currently in trials for GCA which may reshape best guidance on GCA treatment over the next decade.

• #70

  https://link.springer.com/article/10.1007/s11940-020-00660-2

  Giant cell arteritis (GCA), a medium and large vessel vasculitis occurring in the aged, remains a formidable disease, capable of taking both vision and life, through a multitude of vascular complications. […] Advances in our understanding of the immunological cascades underlying the disease have helped guide our search for steroid-sparing treatments for the GCA, the most important of which has been the IL-6 receptor antibody inhibitor tocilizumab, which has been shown to reduce cumulative steroid dose in a large multicenter, placebo-controlled prospective study. […] GCA is no longer a disease whose diagnosis is based exclusively on temporal artery biopsy and whose complications are prevented solely with the use of corticosteroids. Modern vascular imaging techniques and targeted immunologic therapies are heralding a new era for the disease, in which practitioners will hopefully be able to diagnosis it with greater accuracy and treat it with less ischemic complications and iatrogenic side effects.

• #71

  https://link.springer.com/article/10.1007/s11940-020-00660-2

  The GiACTA trial was the first study to provide evidence for a steroid-sparing agent in the management of giant arteritis based on prospective, placebo-controlled design. It has revolutionized the way we treat giant cell arteritis, as the use of the IL-6 inhibitor tocilizumab could lead to a significant reduction of steroid usage (and side effects) in the disease. […] The recommendations of the EULAR that tocilizumab should be considered an add-on drug in patients with refractory or relapsing disease, or in whom a risk factor such as diabetes mellitus increases the risk of glucocorticoid-associated complications have put the findings of the GiACTA trial into practice.

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