Patients with giant cell arteritis (GCA) in France were kept on glucocorticoids at worrisome levels that led to clinically significant adverse effects, insurance data indicated.
Just looking at patients newly diagnosed in 2022 and followed for 2 years, their cumulative mean dose was 7.6 g in prednisone equivalents — more than 10 mg/day over the entire interval — with each gram raising their risk of death by 2.4% (HR 1.024, 95% CI 1.021-1.027), reported Florence Tubach, MD, PhD, of HoÌ‚pital Pitié Salpêtrière in Paris, and colleagues.
Rates of major adverse cardiovascular events (MACE) and infections were increased even at relatively low doses, the group noted in RMD Open. Among patients getting an annual average of 5 mg/day or less in prednisone equivalents, infection risk rose by 13% (HR 1.13, 95% CI 1.00-1.29) and risk for MACE increased by 4% (HR 1.04, 95% CI 1.01-1.08), compared with patients with no glucocorticoid exposure.
But Tubach and colleagues had good news, too, from their study of 18,301 patients diagnosed from 2010 to 2022. Only about 15% of patients started on high doses (60 mg/day or higher), and two-thirds of these had a relatively quick taper such that their mean daily dose was less than 10 mg/day by month 6. Moreover, fewer patients were given these high-dose regimens as time went on — close to 20% in 2010 falling to about 10% in 2022.
Still, the researchers were disturbed that mean doses overall still remained higher than 10 mg/day for patients diagnosed in 2022, despite increased use of alternative medications such as methotrexate and the interleukin-6 inhibitor tocilizumab (Actemra).
Burden of Glucocorticoid Exposure
Our findings highlight that the burden associated with cumulative GC [glucocorticoid] exposure remains important, and that even low GC doses do not appear to be safe,
Fuente: https://www.medpagetoday.com/rheumatology/generalrheumatology/122092
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