title: Effectiveness and safety of medium-dose prednisone in giant cell arteritis: a retrospective cohort study of 103 patients.
abstract: OBJECTIVE
  To compare the effectiveness and safety of medium-dose (MD) and high-dose (HD) prednisone regimens and to identify factors related to remission with a target maintenance dose of prednisone in patients with giant cell arteritis (GCA).
  
  
  METHODS
  Retrospective cohort study conducted in an autoimmune diseases unit. Patients received ≤ 30 mg (MD group) or >30 mg (HD group) of daily prednisone as monotherapy or combined with methylprednisolone pulses and/or methotrexate, at the discretion of the physician. The primary endpoint was time to clinical and biological remission receiving a prednisone maintenance dose ≤ 7.5 mg/day. Factors related to the primary endpoint were identified by Cox regression analysis.
  
  
  RESULTS
  Overall, 103 patients (MD=53, HD=50) were followed for a median (95%CI) of 2.85 (2.57-3.52) years. Both groups exhibited similar baseline features except for ocular ischaemic manifestations (MD=21%, HD=48%, p=0.004). Patients in the MD group had a shorter time to the primary endpoint (MD=186 [147-223], HD=236 [177-276] days, HR=1.70 [1.12-2.57], p=0.01) with no increase in relapses (MD=39%, HD=50%, p=0.29) or GCA complications (MD=11%, HD=16%, p=0.49). Cumulative prednisone doses at 6 months were 2.47 ± 0.70 g for MD patients and 3.86 ± 1.85 g for HD patients (p<0.001). Adverse effects were more frequent among HD recipients (MD=43%, HD=66%, p=0.02). The only independent factor associated with the primary endpoint was the use of methylprednisolone pulses (HR=2.21 [1.31-3.71], p=0.003).
  
  
  CONCLUSIONS
  MD prednisone regimen may be an effective and safe alternative to HD prednisone regimen in GCA. Induction with methylprednisolone pulses predicts a better response, allowing for a less intensive prednisone regimen.
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, Bizkaia, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Les
authors.affiliation: Clinical Epidemiology Unit, BioCruces Health Research Institute, Hospital Universitario Cruces, Bizkaia, and 4Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Spain.
authors.forename: J I
authors.initials: JI
authors.lastname: Pijoán
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, Bizkaia, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Rodríguez-Álvarez
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, Bizkaia, and University of the Basque Country, Bizkaia, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Ruiz-Irastorza
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, Bizkaia, and University of the Basque Country, Bizkaia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Martínez-Berriotxoa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000139:chemically induced; D004359:Drug Therapy, Combination; D005260:Female; D013700:Giant Cell Arteritis / Q000188:drug therapy*; D006801:Humans; D006937:Hypercholesterolemia / Q000139:chemically induced; D006973:Hypertension / Q000139:chemically induced; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000139:chemically induced; D011241:Prednisone / Q000008:administration & dosage*; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D011241:Prednisone; D008775:Methylprednisolone; D008727:Methotrexate