Deflazacort versus prednisone in patients with giant cell arteritis: effects on bone mass loss.
OBJECTIVE
To compare bone mass loss due to deflazacort versus prednisone in longterm treatment of patients with giant cell arteritis (GCA) in a randomized double blind comparative trial.


METHODS
Seventy-four patients were included in a prospective multicenter study. Half received deflazacort (DFZ) and the other half prednisone (PR) for a minimum of 12 months. Calcium and vitamin D supplements were also provided to all subjects. Our intent was (1) to evaluate bone mineral density, using dual energy x-ray absorptiometry, at baseline and comparatively at 3, 6, and 12 mo; vertebral fractures by Meunier score and size variations after 12 mo treatments were also analyzed; (2) to assess calcium/phosphate metabolism modifications in both groups at baseline and after 12 mo.


RESULTS
No significant difference was observed between the 2 groups in terms of treatment efficacy. Patients taking PR were slightly older on average versus the DFZ group (74 vs 70 yrs). Bone mass loss between entry and month 12 was not statistically different in the PR group (-0.026 +/- 0.007 g/cm2) compared to the DFZ group (-0.03 +/- 0.005 g/cm2). No significant difference was found in Meunier score variations (0.77 and 1.18 in the PR and DFZ groups, respectively; p = 0.3), nor in vertebral size variations (-0.4 and -0.2 in the PR and DFZ groups, respectively; p = 0.4). There was no difference in calcium/phosphate metabolism evaluations at month 12.


CONCLUSIONS
In older patients taking longterm glucocorticoids who are at risk of osteoporosis, deflazacort did not result in less bone loss than prednisone.
Cacoub
P
P
Service de Médecine Interne, Hôpital La Pitié-Salpêtrière, Paris, France. patrice.cacoub@psl.ap-hop-paris.fr
Chemlal
K
K
Khalifa
P
P
Wechsler
B
B
De Gennes
C
C
Belmatoug
N
N
Cohen
P
P
Ziza
J M
JM
Verdoncq
B
B
Piette
J C
JC
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D015519:Bone Density / Q000187:drug effects; D001851:Bone Diseases, Metabolic / Q000139:chemically induced* / Q000517:prevention & control; D002118:Calcium / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D013700:Giant Cell Arteritis / Q000188:drug therapy*; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011241:Prednisone / Q000009:adverse effects*; D011282:Pregnenediones / Q000009:adverse effects*; D011446:Prospective Studies; D016103:Spinal Fractures / Q000209:etiology; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011282:Pregnenediones; D014807:Vitamin D; C021988:deflazacort; D002118:Calcium; D011241:Prednisone