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A Randomized, Multicenter, Controlled Trial Using Intravenous Pulses of Methylprednisolone in the Initial Treatment of Simple Forms of Giant Cell Arteritis: A One Year Followup Study of 164 PatientsPASCAL CHEVALET, JACQUES–HENRI BARRIER, PIERRE POTTIER, GENEVIEVE MAGADUR–JOLY, MARIE–ANTOINETTE POTTIER, MOHAMED HAMIDOU, BERNARD PLANCHON, DOMINIQUE EL KOURI, LOIK CONNAN, JEAN–LOUIS DUPOND, BRUNO DE WAZIERES, GEORGES DIEN, ELISABETH DUHAMEL, BERNARD GROSBOIS, PATRICK JEGO, ANNE LE STRAT, JEAN CAPDEVILLE, PHILIPPE LETELLIER, LOUISE AGRON, and Members of the Study Group ABSTRACT. Methods. Patients received a 240 mg iv pulse of MP followed by 0.7 mg/kg/day oral prednisone (Group 1), or 0.7 mg/kg/day prednisone without an iv pulse (Group 2, controls), or a 240 mg iv pulse of MP followed by 0.5 mg/kg/day prednisone (Group 3). Corticosteroid dosage was reduced after normalization of 2 biological inflammatory variables to obtain half–dosage after 4 weeks in Groups 1 and 2 and 20 mg/day after 2 weeks in Group 3. Tapering was systematically attempted from the 6th month of treatment. Results. One hundred sixty–four patients were included in the trial (1992–96). Cumulative doses of corticosteroids after one year were identical for all groups (p = 0.39). No significant differences were observed in the time required for normalization of C–reactive protein, corticosteroid resistance (13.5%), and corticosteroid related side effects (39% of patients; p = 0.37). Corticosteroid resistant patients received larger doses and showed a high risk of GCA related complications (p = 0.02). Conclusion. MP pulses have no significant longterm, corticosteroid sparing effects in the treatment of simple forms of GCA and should be limited to complicated forms. Moreover, corticosteroid resistance is a real risk factor for GCA complications. (J Rheumatol 2000;27:1484–91) Key Indexing Terms:
GIANT CELL ARTERITIS |
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