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SAN ANTONIO — The use of high-dose pulsed intravenous glucocorticoid infusions may provide a means of effectively inducing remission in patients with giant cell arteritis, Mehrdad Mazlumzadeh, M.D., said at the annual meeting of the American College of Rheumatology.
First-line treatment for this condition, in which the arteries of the head and neck become inflamed, is with oral prednisone. This approach leads to rapid suppression of the inflammatory processes and resulting symptoms, which can include headache, fatigue, and even blindness. Inflammatory infiltrates persist in the temporal arteries, however, and many patients relapse.
And because extended courses of oral therapy typically are needed, patients are at risk for the many adverse effects associated with long-term steroid exposure, said Dr. Mazlumzadeh, a rheumatologist at the Mayo Clinic, Rochester, Minn.
In a study that included 27 patients with biopsy-proven giant cell arteritis, all participants received oral prednisone in a dose of 40 mg/day. They also were randomized to receive either pulse IV methylprednisolone, 15 mg/kg per day for 3 days, or intravenous saline.
The goal was to determine if high-dose pulse methylprednisolone as the initial treatment of giant cell arteritis would allow for more rapid tapering of oral prednisone without increasing the number of relapses. The primary outcome was reduction in the oral prednisone dose to no more than 5 mg/day after 34 weeks of therapy. “The results were impressive,” Dr. Mazlumzadeh said.
Of the 14 patients in the intravenous treatment group, 10 achieved the primary outcome vs. 2 of 13 in the control group—71% vs. 15%, a statistically significant difference.
Remission was defined as being off prednisone altogether with no recurrences for at least 2 months. Six of the active treatment patients were in remission at 18 months. None of the control patients achieved remission, he said.
There were 21 disease flares in the active treatment group and 34 in the control group. The rate of relapses per 100 person-months of treatment in the control group was 14.5, compared with 8.3 in the active treatment group.
The median cumulative dose of prednisone in the active treatment group was 4,853 mg, compared with 7,215 mg in the control group.
There were no differences between the groups in terms of the development of steroid-associated complications including osteoporosis, hypertension, hyperlipidemia, and diabetes.
No life-threatening disease-associated complications or vision loss occurred. One patient in the intravenous treatment group developed pyelonephritis 11 days after starting therapy.
SAN ANTONIO — The use of high-dose pulsed intravenous glucocorticoid infusions may provide a means of effectively inducing remission in patients with giant cell arteritis, Mehrdad Mazlumzadeh, M.D., said at the annual meeting of the American College of Rheumatology.
First-line treatment for this condition, in which the arteries of the head and neck become inflamed, is with oral prednisone. This approach leads to rapid suppression of the inflammatory processes and resulting symptoms, which can include headache, fatigue, and even blindness. Inflammatory infiltrates persist in the temporal arteries, however, and many patients relapse.
And because extended courses of oral therapy typically are needed, patients are at risk for the many adverse effects associated with long-term steroid exposure, said Dr. Mazlumzadeh, a rheumatologist at the Mayo Clinic, Rochester, Minn.
In a study that included 27 patients with biopsy-proven giant cell arteritis, all participants received oral prednisone in a dose of 40 mg/day. They also were randomized to receive either pulse IV methylprednisolone, 15 mg/kg per day for 3 days, or intravenous saline.
The goal was to determine if high-dose pulse methylprednisolone as the initial treatment of giant cell arteritis would allow for more rapid tapering of oral prednisone without increasing the number of relapses. The primary outcome was reduction in the oral prednisone dose to no more than 5 mg/day after 34 weeks of therapy. “The results were impressive,” Dr. Mazlumzadeh said.
Of the 14 patients in the intravenous treatment group, 10 achieved the primary outcome vs. 2 of 13 in the control group—71% vs. 15%, a statistically significant difference.
Remission was defined as being off prednisone altogether with no recurrences for at least 2 months. Six of the active treatment patients were in remission at 18 months. None of the control patients achieved remission, he said.
There were 21 disease flares in the active treatment group and 34 in the control group. The rate of relapses per 100 person-months of treatment in the control group was 14.5, compared with 8.3 in the active treatment group.
The median cumulative dose of prednisone in the active treatment group was 4,853 mg, compared with 7,215 mg in the control group.
There were no differences between the groups in terms of the development of steroid-associated complications including osteoporosis, hypertension, hyperlipidemia, and diabetes.
No life-threatening disease-associated complications or vision loss occurred. One patient in the intravenous treatment group developed pyelonephritis 11 days after starting therapy.
SAN ANTONIO — The use of high-dose pulsed intravenous glucocorticoid infusions may provide a means of effectively inducing remission in patients with giant cell arteritis, Mehrdad Mazlumzadeh, M.D., said at the annual meeting of the American College of Rheumatology.
First-line treatment for this condition, in which the arteries of the head and neck become inflamed, is with oral prednisone. This approach leads to rapid suppression of the inflammatory processes and resulting symptoms, which can include headache, fatigue, and even blindness. Inflammatory infiltrates persist in the temporal arteries, however, and many patients relapse.
And because extended courses of oral therapy typically are needed, patients are at risk for the many adverse effects associated with long-term steroid exposure, said Dr. Mazlumzadeh, a rheumatologist at the Mayo Clinic, Rochester, Minn.
In a study that included 27 patients with biopsy-proven giant cell arteritis, all participants received oral prednisone in a dose of 40 mg/day. They also were randomized to receive either pulse IV methylprednisolone, 15 mg/kg per day for 3 days, or intravenous saline.
The goal was to determine if high-dose pulse methylprednisolone as the initial treatment of giant cell arteritis would allow for more rapid tapering of oral prednisone without increasing the number of relapses. The primary outcome was reduction in the oral prednisone dose to no more than 5 mg/day after 34 weeks of therapy. “The results were impressive,” Dr. Mazlumzadeh said.
Of the 14 patients in the intravenous treatment group, 10 achieved the primary outcome vs. 2 of 13 in the control group—71% vs. 15%, a statistically significant difference.
Remission was defined as being off prednisone altogether with no recurrences for at least 2 months. Six of the active treatment patients were in remission at 18 months. None of the control patients achieved remission, he said.
There were 21 disease flares in the active treatment group and 34 in the control group. The rate of relapses per 100 person-months of treatment in the control group was 14.5, compared with 8.3 in the active treatment group.
The median cumulative dose of prednisone in the active treatment group was 4,853 mg, compared with 7,215 mg in the control group.
There were no differences between the groups in terms of the development of steroid-associated complications including osteoporosis, hypertension, hyperlipidemia, and diabetes.
No life-threatening disease-associated complications or vision loss occurred. One patient in the intravenous treatment group developed pyelonephritis 11 days after starting therapy.