THU0447 No advantage of methotrexate in the treatment of giant cell arteritis. (12th June 2018)

• Record Type: Journal Article
• Authors: Monjo Henry, I.; Coronel, Luis; Castaño, Ignacio; Peiteado, Diana; García-Carazo, Sara; Balsa, Alejandro; Miguel, Eugenio de
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 435
• Page End: 436
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.7148
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: The high-dose glucocorticoids (GCs) are the mainstay of treatment in Giant Cell Arteritis (GCA). Patients treated with greater GCs dosages are at the greatest risk of morbidity. Immunosuppressive agents have been trialled in an effort to reduce toxicity from GCs and to improve efficacy of treatment. The results of one meta-analysis with the three trials that included methotrexate (MTX) showed a weak benefit in those patients receiving MTX, but the results were heterogeneous, with one trial showing significant benefit, while the other two did not. 1 Objectives: To study the efficacy and safety of MTX adjunct to GCs in the treatment of GCA. Methods: New-onset giant-cell arteritis initiating treatment of the disease was included in a retrospective observational study to compare treatment efficacy and safety. According to the treatment received the patients were divided two groups: GCs alone (group 1) and MTX and GCs (group 2). To avoid bias, we defined a subgroup of patients in which only patients who started MTX in the first trimester of treatment were included (group 3). As efficacy outcome the number of relapses and the cumulative dose of GCs at 6, 12 and 24 months were collected. For safety, the number of emergency room visits, hospitalisation admissions and infections were investigated in the follow-up. Results: One hundred twenty- three patients were included, 74 (60.2%) women, the mean age was 79, 41 years old. Fifty-six (45.53%) received GCs alone (group 1) and 67 (54.48%) received GCs and MTX as an adjuvant treatment at some time during follow- up (group 2). 30 of these 83 patients (24.39% of total patients) received MTX in the first trimester after diagnosis (group 3). The cumulative doses of GCs, number of patients with relapses, visits to the emergency room and hospitalisation admissions are shown in the table 1. In none of these variables there were statistically significant differences among the three groups, except for the number of patients with relapses, which was greater in group 2 than in group 1 (p=0.03). The number of relapses in patients who received MTX early (group 3) was 56.7%, in the rest of patients (who only received GCs and those who started MTX after the first trimester) was 52.69%–33.3% of the patients in group 3% and 21.5% of the rest of the patients presented infections. Conclusions: Whilst MTX have been used in an effort to reduce toxicity from GCs and to improve efficacy of treatment our observational study shows that there is no benefit from adjunct MTX in GCA either in terms of efficacy or toxicity. Reference: [1] Mahr AD, Jover JA, Spiera RF, et al. Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data metaanalysis. Arthritis Rheum2007;56(8):2789–2797. Disclosure of Interest: None declared