Efficacy and tolerance of methotrexate in a real-life monocentric cohort of patients with giant cell arteritis |
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| Institution: | 1. Department of Internal Medicine, Caen University Hospital, Caen, France;2. Caen University-Normandie, Caen, France;1. Division of Rheumatology, Department of Medicine, Rush University School of Medicine, Chicago, IL 60612, USA;2. Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC 20057, USA;3. Department of Rheumatology, Hospital Clinic Universitari de Barcelona, Institut d´investigacions Biomèdiques August Pi i Sunyer, Barcelona 08036, Spain;1. 1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;2. Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy;3. Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;4. Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;1. Rheumatology Division, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain;2. IDIVAL, Research group on genetic epidemiology and atherosclerosis in systemic diseases and inmetabolic bone diseases of the musculoskeletal system, Santander, Spain;3. Rheumatology Division, Hospital Universitario Marqués de Valdecilla, Santander, Spain;4. Rheumatology Division, Hospital Sierrallana, Torrelavega, Spain;5. Rheumatology Division, Hospital Comarcal de Laredo, Laredo, Spain;6. Rheumatology Division, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain;7. Rheumatology Division, Hospital Universitario Reina Sofía, Córdoba, Spain;8. Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain;9. Rheumatology Division, Hospital Universitario de San Juan, Alicante, Spain;10. Rheumatology Division, Hospital General Universitario de Alicante, Alicante, Spain;11. Rheumatology Division, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain;12. Rheumatology Division, Hospital Universitario La Paz, Madrid, Spain;13. Rheumatology Division, Hospital Universitario Basurto, Bilbao, Spain;14. Rheumatology Division, Hospital of Galdakao-Usansolo, Galdakao, Spain;15. Diagnóstico Médico Cantabria (DMC), Santander, Spain;p. Rheumatology Division, Hospital Universitario Reina Sofía, Murcia, Spain;q. IDIVAL and Department of Medicine and Psychiatry, School of Medicine, Universidad de Cantabria, Santander, Spain;r. Rheumatology Division, IIS-Fundación Jiménez Díaz, Madrid, Spain;1. University of Washington, Seattle, WA, United States;2. Division of Rheumatology, Department of Internal Medicine, University of Washington, Seattle, WA, United States;3. University Libraries, University of Washington, Seattle, WA, United States;4. Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, United States;1. Mayo Clinic Department of Medicine, Division of Rheumatology, Jacksonville, FL 32224, USA;2. Mayo Clinic Departments of Dermatology and Laboratory Medicine & Pathology, Jacksonville, FL 32224, USA;1. Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada;2. Division of Nephrology, Department of Medicine, London Health Sciences Centre and Western University, London, Ontario, Canada;3. Division of Rheumatology, Department of Medicine, London Health Sciences Centre and Western University, London, Ontario, Canada |
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| Abstract: | ObjectivesTo assess the indications, efficiency and tolerance profiles of methotrexate (MTX) in patients with giant cell arteritis (GCA) in a real-life setting.MethodsFrom a monocentric database of >500 GCA patients, we retrospectively selected 49 patients who received MTX between 2010 and 2020. Cumulative glucocorticoid (GC) doses, the number of relapses and GC-related adverse events were recorded before, during and after MTX. We separately analyzed the 3 main indications of MTX, i.e., disease relapse, GC-sparing strategy, and GCA presentation.ResultsWith a median follow-up of 84 10–255] months, 25 (51%) and 18/41 (44%) patients relapsed during MTX treatment and after its discontinuation, respectively. Among the 40 patients who relapsed before MTX, 26 (65%) experienced a new relapse after MTX introduction. Once MTX was introduced, 24 (49%) patients were able to discontinue GC after 20.5 7–64] months. No significant difference in cumulative GC doses were noted before and after MTX introduction with a total GC dose of 14.7 1.05–69.4] grams. At the last follow-up, MTX was discontinued in 41 patients, including 13 (32%) due to clinicobiological remission, 12 (30%) due to treatment failure and 15 (36%) due to side effects.ConclusionOur real-life study showed a modest beneficial effect of MTX on relapse in patients with GCA. However, we did not observe any GC-sparing effect in this study. Other studies are needed to assess the GC-sparing effect in patients in whom GC management is adapted from recent recommendations. |
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