Efficacy and tolerance of methotrexate in a real-life monocentric cohort of patients with giant cell arteritis

• Published in: Seminars in arthritis and rheumatism Vol. 60; p. 152192
• Main Authors: Lavergne, Amandine, Dumont, Anael, Deshayes, Samuel, Boutemy, Jonathan, Maigné, Gwénola, Silva, Nicolas Martin, Nguyen, Alexandre, Gallou, Sophie, Philip, Rémi, Aouba, Achille, de Boysson, Hubert
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2023
• Subjects: Adverse events; Cumulative glucocorticoid doses; Giant cell arteritis; Giant Cell Arteritis - drug therapy; Glucocorticoids; Glucocorticoids - therapeutic use; Glucocorticoids sparing effect; Humans; Methotrexate; Methotrexate - therapeutic use; Recurrence; Relapse; Retrospective Studies; Relapse; Glucocorticoids; Adverse events; Giant cell arteritis; Methotrexate; Cumulative glucocorticoid doses; Glucocorticoids sparing effect
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2023.152192

•Two-third of GCA patients with relapsing disease experienced a new relapse after methotrexate introduction.•In this real-life study, no glucocorticoid sparing effect was obtained with methotrexate use.•One third of GCA patients who received methotrexate discontinued the treatment for adverse events. To assess the indications, efficiency and tolerance profiles of methotrexate (MTX) in patients with giant cell arteritis (GCA) in a real-life setting. From a monocentric database of >500 GCA patients, we retrospectively selected 49 patients who received MTX between 2010 and 2020. Cumulative glucocorticoid (GC) doses, the number of relapses and GC-related adverse events were recorded before, during and after MTX. We separately analyzed the 3 main indications of MTX, i.e., disease relapse, GC-sparing strategy, and GCA presentation. With a median follow-up of 84 [10–255] months, 25 (51%) and 18/41 (44%) patients relapsed during MTX treatment and after its discontinuation, respectively. Among the 40 patients who relapsed before MTX, 26 (65%) experienced a new relapse after MTX introduction. Once MTX was introduced, 24 (49%) patients were able to discontinue GC after 20.5 [7–64] months. No significant difference in cumulative GC doses were noted before and after MTX introduction with a total GC dose of 14.7 [1.05–69.4] grams. At the last follow-up, MTX was discontinued in 41 patients, including 13 (32%) due to clinicobiological remission, 12 (30%) due to treatment failure and 15 (36%) due to side effects. Our real-life study showed a modest beneficial effect of MTX on relapse in patients with GCA. However, we did not observe any GC-sparing effect in this study. Other studies are needed to assess the GC-sparing effect in patients in whom GC management is adapted from recent recommendations.