Effectiveness and safety of medium-dose prednisone in giant cell arteritis: a retrospective cohort study of 103 patients.

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).,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.,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).,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.