Glucocorticoid monotherapy versus combination with methotrexate or tocilizumab in giant cell arteritis: efficacy and safety at 78 weeks in a retrospective cohort study.

The classic treatment for giant cell arteritis (GCA) is based on glucocorticoids (GC), whose prolonged use causes adverse effects. Therefore, GC-sparing drugs are used, although few direct comparative studies exist. We assessed the efficacy and safety of GC monotherapy (GCmono), GC with methotrexate (GC+MTX), and GC with tocilizumab (GC+TCZ). Retrospective cohort study of patients with GCA. A composite endpoint (REACT-G) was defined that included relapses, serious infections, and GC-related adverse events at 78 weeks, and the cumulative dose of GC was analyzed. A total of 52 patients were included; 15 received GCmono, 30 received GC+MTX, and 7 received GC+TCZ. The REACT-G endpoint occurred in 27 patients, mainly due to relapses. GC+TCZ was associated with a lower REACT-G rate (14%) than GCmono (67%) and GC+MTX (53%) (p=0.082). In the GC+MTX group, the REACT-G was lower with higher doses of MTX (p=0.009). In the multivariate analysis, the use of GC+TCZ was the only independent protective factor against REACT-G (p=0.038). The cumulative GC dose at 78 weeks was higher in the GCmono group (7143.7±2977.7mg) than in GC+MTX group (5273.2±1745.3mg; p=0.032) and GC+TCZ group (3733.9±2286.8mg; p=0.005). In the multivariate analysis, only the GC+TCZ group accumulated significantly lower GC doses (p=0.034). Compared with GCmono, GC+TCZ combination was associated with a significant reduction in REACT-G events in the multivariate analysis and a lower cumulative dose of GC at 78 weeks. The benefit of GC+MTX was moderate and, like the prevention of REACT-G events, appears to be dose-dependent.