Objectives To evaluate the effect of early glucocorticoid treatment in new-onset giant cell arteritis (GCA) on relapse occurrence during glucocorticoid tapering, and on glucocorticoid dosages. Methods This retrospective cohort study included adults with GCA managed between 2017–2023 with at least three months of follow-up. Data collected included demographics, symptoms, treatment onset, glucocorticoid dosing, and disease relapses for up to 24 months after diagnosis. Early treatment was defined as initiation of glucocorticoids within 7 days of symptom onset. Disease relapses during the first glucocorticoid taper were defined as symptom recurrence or increased inflammatory markers attributed to GCA during or within three months of glucocorticoid tapering. Relapse free survival was estimated using Kaplan–Meier analysis. Glucocorticoid dosing was compared using the Mann–Whitney U Test. Results Ninety patients (mean age 74.8 years, 70% female) with GCA met the inclusion criteria. Median time from symptom onset to glucocorticoid administration was 13 days, with 34 (37.8%) patients receiving treatment within one week. Overall, 47 (52.2%) experienced a relapse during their first glucocorticoid taper. Early treatment was associated with significantly reduced odds of having a relapse during the first glucocorticoid taper (OR = 0.214, 95%CI = 0.085–0.538; p = 0.001), and increased mean relapse-free survival (17 vs 11.6 months, p = 0.011). This effect persisted after adjusting for demographics, symptoms, inflammatory markers, biopsy results, glucocorticoid doses, and tocilizumab co-administration. Additionally, early treatment was associated with significantly lower median glucocorticoids doses at 3-, 6-, and 9-month intervals. Conclusion Early initiation of glucocorticoids in patients with GCA is associated with increased relapse-free survival and reduced glucocorticoids dosages.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> Key Points • Glucocorticoid treatment within seven days of symptom onset reduced the risk of GCA relapse. • Early glucocorticoid treatment prolongs relapse-free survival in patients with GCA. • Initiating glucocorticoids early in GCA is associated with reduced glucocorticoid doses during the tapering period. </entry> </row> </tbody> </tgroup> </Table>

Impact of early treatment on the relapse-free survival and glucocorticoid dosing in giant cell arteritis: a retrospective cohort study

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发表日期：

2025年7月5日

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Eleni Papachristodoulou,
Loukas Kakoullis,
Shiv Tej Sehra

摘要

Objectives

To evaluate the effect of early glucocorticoid treatment in new-onset giant cell arteritis (GCA) on relapse occurrence during glucocorticoid tapering, and on glucocorticoid dosages.

Methods

This retrospective cohort study included adults with GCA managed between 2017–2023 with at least three months of follow-up. Data collected included demographics, symptoms, treatment onset, glucocorticoid dosing, and disease relapses for up to 24 months after diagnosis. Early treatment was defined as initiation of glucocorticoids within 7 days of symptom onset. Disease relapses during the first glucocorticoid taper were defined as symptom recurrence or increased inflammatory markers attributed to GCA during or within three months of glucocorticoid tapering. Relapse free survival was estimated using Kaplan–Meier analysis. Glucocorticoid dosing was compared using the Mann–Whitney U Test.

Results

Ninety patients (mean age 74.8 years, 70% female) with GCA met the inclusion criteria. Median time from symptom onset to glucocorticoid administration was 13 days, with 34 (37.8%) patients receiving treatment within one week. Overall, 47 (52.2%) experienced a relapse during their first glucocorticoid taper. Early treatment was associated with significantly reduced odds of having a relapse during the first glucocorticoid taper (OR = 0.214, 95%CI = 0.085–0.538; p = 0.001), and increased mean relapse-free survival (17 vs 11.6 months, p = 0.011). This effect persisted after adjusting for demographics, symptoms, inflammatory markers, biopsy results, glucocorticoid doses, and tocilizumab co-administration. Additionally, early treatment was associated with significantly lower median glucocorticoids doses at 3-, 6-, and 9-month intervals.

Conclusion

Early initiation of glucocorticoids in patients with GCA is associated with increased relapse-free survival and reduced glucocorticoids dosages.

Key Points

• Glucocorticoid treatment within seven days of symptom onset reduced the risk of GCA relapse.

• Early glucocorticoid treatment prolongs relapse-free survival in patients with GCA.

• Initiating glucocorticoids early in GCA is associated with reduced glucocorticoid doses during the tapering period.