title: Mycophenolate mofetil as steroid-sparing treatment for elderly patients with giant cell arteritis: report of three cases.
abstract: OBJECTIVE
  Glucocorticoids have never been studied in a placebo-controlled manner in giant cell arteritis (GCA), but their effectiveness is well established. However, evidence for the efficacy of immunosuppressant drugs as steroid-sparing agents in this disease is highly desirable, especially in elderly patients. We report the use of mycophenolate mofetil (MMF) as a steroid-sparing agent in three patients (mean age 78 years) with GCA, at high risk of longterm high dose glucocorticoids because of type II diabetes mellitus, obesity, hypertension or osteoporosis.
  
  
  METHODS
  clinical monitoring and assessment of laboratory parameters were carried out weekly (first month) and then patients were seen in the clinic every 2 weeks. Vascular lesions were also monitored at the onset and during the follow-up by Doppler ultrasonography (every 3 months).
  
  
  RESULTS
  all three patients showed clinical benefit, and were also able to taper steroid use to a more rapid regimen compared with the recently suggested steroid reduction approach. MMF was well tolerated, and no signs of toxicity were observed in a mean of 21.6 months (12-29) of follow-up.
  
  
  CONCLUSIONS
  mycophenolate mofetil may be considered a steroid-sparing agent in elderly patients with GCA but, before results of controlled trials become available, MMF may be considered only for patients who do not improve or stabilize with conventional therapy, or in patients for whom reduced steroid dosage is highly recommended.
authors.affiliation: Dipartimento di Malattie Rare, Immunologiche, Ematologiche ed Immunopatologiche, Centro di Ricerche di Immunopatologia e Documentazione su Malattie Rare, Struttura Complessa a Direzione Universitaria di Immunologia Clinica, Ospedale Torino Nord, Emergenza San G. Bosco ed Università di Torino, Italy.
authors.forename: Savino
authors.initials: S
authors.lastname: Sciascia
authors.forename: Doloretta
authors.initials: D
authors.lastname: Piras
authors.forename: Simone
authors.initials: S
authors.lastname: Baldovino
authors.forename: Alessandra
authors.initials: A
authors.lastname: Russo
authors.forename: Carla
authors.initials: C
authors.lastname: Naretto
authors.forename: Daniela
authors.initials: D
authors.lastname: Rossi
authors.forename: Mirella
authors.initials: M
authors.lastname: Alpa
authors.forename: Dario
authors.initials: D
authors.lastname: Roccatello
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D013700:Giant Cell Arteritis / Q000188:drug therapy* / Q000378:metabolism; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013256:Steroids / Q000008:administration & dosage*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D013256:Steroids; D009173:Mycophenolic Acid