Evaluation of adjunctive mycophenolate for large vessel giant cell arteritis

Karabayas, M., Dospinescu, P., Fluck, N., Kidder, D., Fordyce, G., Hollick, R.J., De Bari, C. and Basu, N. (2020) Evaluation of adjunctive mycophenolate for large vessel giant cell arteritis. Rheumatology Advances in Practice, 4(2), rkaa069. (doi: 10.1093/rap/rkaa069) (PMID:33381680) (PMCID:PMC7756006)

Abstract

Objectives: GCA patients with large vessel involvement (LV-GCA) experience greater steroid requirements and higher relapse rates, compared to classical cranial GCA. Despite the distinct disease course, interventions in LV-GCA have yet to be specifically investigated. This study aimed to evaluate the steroid sparing effect and tolerability of first-line mycophenolate in LV-GCA. Methods: A retrospective cohort study was conducted in patients with LV-GCA identified from a regional clinical database between 2005 and 2019. All cases were prescribed mycophenolate derivatives (mycophenolate mofetil or mycophenolic acid, MYC) at diagnosis and were followed up for at least 2 years. The primary outcome was cumulative steroid dose at 1 year. Secondary outcomes included MYC tolerance, relapse rates and CRP levels at 1 and 2 years. Results: A total of 37 patients (65% female; mean age 69.4, SD7.9) were identified. All cases demonstrated large vessel involvement via CT/PET n=34, CTA n=5 or MRA n=2. After 2 years, 31 patients remained on MYC, whilst 6 switched to methotrexate or tocilizumab due to significant disease relapse. The mean cumulative prednisolone dose at 1 year was 4960 (±1621) mg. Relapse rates at 1 and 2 years were 16.2% and 27% respectively, whilst CRP levels at 1 and 2 years were 4 mg/L (IQR 4-6 mg/L) and 4 mg/L (IQR 4-4 mg/L) respectively. Conclusion: To our knowledge, this is the first effort to assess the effectiveness of any specific agent in LV-GCA. MYC may be both effective in reducing steroid exposure and well tolerated in this sub-population. A future randomised controlled trial is warranted.

• Item Type: Articles
• Additional Information: We are grateful to Versus Arthritis (grant 22088) and PMR/GCA for supporting our work.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Basu, Professor Neil
• Authors: Karabayas, M., Dospinescu, P., Fluck, N., Kidder, D., Fordyce, G., Hollick, R.J., De Bari, C., and Basu, N.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: Rheumatology Advances in Practice
• Publisher: Oxford University Press
• ISSN: 2514-1775
• ISSN (Online): 2514-1775
• First Published: First published in Rheumatology Advances in Practice 4(2):rkaa069
• Publisher Policy: Reproduced under a Creative Commons license