Efficacy of Methotrexate in Real-world Management of Giant Cell Arteritis: A Case-control Study.

Abstract

OBJECTIVE:

To determine the effect of methotrexate (MTX) on relapse risk and glucocorticoid (GC) use in a large single-institution cohort of patients with giant cell arteritis (GCA).

METHODS:

Patients diagnosed with GCA from 1998 to 2013 with confirmed evidence of temporal artery biopsy and/or radiographic evidence of large vessel vasculitis were identified. Each patient with GCA treated with adjunct MTX (case) was matched to a similar patient with GCA treated only with GC (control). GC requirements and relapse events before and after MTX initiation (or corresponding index date) were compared using rate ratios (RR).

RESULTS:

Eighty-three cases and 83 controls were identified and compared. No significant differences in age, demographics, laboratory variables, baseline disease characteristics, or mean initial prednisone doses were observed. Median [interquartile range (IQR)] time from GCA diagnosis to MTX initiation in cases was 39 (13-80) weeks and the median (IQR) starting dose was 13.5 (10-15) mg/week. RR comparing relapse rates before and after MTX initiation/index date were significantly reduced in both cases (RR 0.32, 95% CI 0.24-0.41) and controls (RR 0.60, 95% CI 0.43-0.86). The decrease in relapse rate was significantly greater in patients taking MTX than in those taking GC alone (p = 0.004). Rates of GC discontinuation did not differ between groups.

CONCLUSION:

In this large single-institution cohort, the addition of MTX to GC decreased the rate of subsequent relapse by nearly 2-fold compared to patients taking GC alone. MTX may be considered as adjunct therapy in patients with GCA to decrease the risk of further relapse events.

• Authors: Matthew J Koster, Karthik Yeruva, Cynthia S Crowson, Francesco Muratore, Cristian Labarca, Kenneth J Warrington
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 46 Issue 5 Pg. 501-508 (05 2019) ISSN: 0315-162X [Print] Canada
• PMID: 30647171 (Publication Type: Journal Article)

Chemical References

• Prednisone
• Methotrexate

Topics

• Academic Medical Centers
• Aged
• Biopsy, Needle
• Case-Control Studies
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Giant Cell Arteritis (diagnostic imaging, drug therapy)
• Humans
• Male
• Methotrexate (administration & dosage)
• Middle Aged
• North America
• Positron-Emission Tomography (methods)
• Prednisone (administration & dosage)
• Recurrence
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Treatment Outcome