Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data meta-analysis.
Alfred Mahr,Juan Angel Jover,Robert Spiera,César Hernández-García,Benjamín Fernández-Gutiérrez,Michael P. LaValley,Peter A. Merkel +6 more
TLDR
It is indicated that MTX could be considered as a therapeutic option in addition to standard-of-care treatment with corticosteroids for patients with GCA, and adjunctive treatment with MTX lowers the risk of relapse and reduces exposure to cortiosteroids.Abstract:
Objective
To reevaluate the efficacy and safety of adjunctive low-dose methotrexate (MTX) in giant cell arteritis (GCA).
Methods
An individual patient data meta-analysis of 3 randomized placebo-controlled trials in patients with newly diagnosed GCA was performed. Treatment consisted of initial high-dose corticosteroids and randomly assigned oral MTX therapy (7.5–15 mg/week) or placebo. Time-to-event outcomes were compared between groups using Cox proportional hazards models stratified by trial, and continuous outcomes were compared by calculating weighted mean differences.
Results
The combined data set comprised 161 patients, of whom 84 received MTX and 77 received placebo. The mean duration of followup was 54.7 weeks (SD 39.2 weeks). Hazard ratios (HRs) for a first and second relapse of GCA were 0.65 (P = 0.04) and 0.49 (P = 0.02), respectively, in patients receiving MTX as compared with patients receiving placebo. Accordingly, a predicted 3.6 individuals (95% confidence interval [95% CI] 2.2–56.8) and 4.7 individuals (95% CI 3.3–21.9) need to be treated with MTX to prevent the occurrence of one first or one second relapse, respectively, up to 48 weeks. Use of MTX resulted in a reduction in the corticosteroid cumulative dose by 842 mg within 48 weeks (P < 0.001). Moreover, MTX treatment was associated with a higher probability of achieving sustained discontinuation of corticosteroids for ≥24 weeks (HR 2.84, P = 0.001). Dropout rates and occurrence of adverse events did not differ between treatment groups.
Conclusion
In GCA, adjunctive treatment with MTX lowers the risk of relapse and reduces exposure to corticosteroids. These findings indicate that MTX could be considered as a therapeutic option in addition to standard-of-care treatment with corticosteroids for patients with GCA.read more
Citations
More filters
Journal ArticleDOI
2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association
Dawn Kleindorfer,Amytis Towfighi,Seemant Chaturvedi,Kevin M. Cockroft,Jose Gutierrez,Debbie Lombardi-Hill,Hooman Kamel,Walter N. Kernan,Steven J. Kittner,Enrique C. Leira,Olive Lennon,James F. Meschia,Thanh N. Nguyen,Peter M. Pollak,Pasquale Santangeli,Anjail Sharrief,Sidney C. Smith,Tanya N. Turan,Linda S. Williams +18 more
Journal ArticleDOI
Polymyalgia rheumatica and giant-cell arteritis
TL;DR: A greater understanding of the molecular mechanisms involved in the pathogenesis of polymyalgia rheumatica and giant-cell arteritis should provide new targets for therapy.
Journal ArticleDOI
EULAR recommendations for the management of large vessel vasculitis
Chetan Mukhtyar,Loïc Guillevin,Maria C. Cid,Bhaskar Dasgupta,K de Groot,Wolfgang L. Gross,Thomas H. Hauser,Bernhard Hellmich,David Jayne,C. G. M. Kallenberg,Peter A. Merkel,Heiner Raspe,Carlo Salvarani,Dgi Scott,Coen A. Stegeman,Richard A. Watts,Kerstin Westman,James Witter,Halil Yazici,Raashid Luqmani +19 more
TL;DR: Recommendations for large vessel vasculitis have been formulated on the basis of evidence and expert consensus and are commended for use in everyday clinical practice.
Journal ArticleDOI
2018 Update of the EULAR recommendations for the management of large vessel vasculitis.
Bernhard Hellmich,Ana Filipa Águeda,Sara Monti,Frank Buttgereit,Hubert de Boysson,Elisabeth Brouwer,Rebecca Cassie,Maria C. Cid,Bhaskar Dasgupta,Christian Dejaco,Gulen Hatemi,Nicole Hollinger,Alfred Mahr,Susan P Mollan,Chetan Mukhtyar,Cristina Ponte,Carlo Salvarani,Rajappa Sivakumar,Xinping Tian,Gunnar Tomasson,Carl Turesson,Wofgang Schmidt,Peter M. Villiger,Richard A. Watts,Chris Young,Raashid Luqmani +25 more
TL;DR: The recommendations for the management of LVV have been updated to facilitate the translation of current scientific evidence and expert opinion into better management and improved outcome of patients in clinical practice.
Journal ArticleDOI
Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial
Peter M. Villiger,Sabine Adler,Stefan Kuchen,Felix Wermelinger,Diana Dan,Veronika Fiege,Lukas Bütikofer,Michael Seitz,Stephan Reichenbach +8 more
TL;DR: The findings show, for the first time in a trial setting, the efficacy of tocilizumab in the induction and maintenance of remission in patients with giant cell arteritis.
References
More filters
Journal ArticleDOI
Polymyalgia rheumatica and giant-cell arteritis.
Journal ArticleDOI
Randomized trial of cyclophosphamide versus methotrexate for induction of remission in early systemic antineutrophil cytoplasmic antibody–associated vasculitis
Kirsten de Groot,Niels Rasmussen,Paul A. Bacon,Jan Willem Cohen Tervaert,Conleth Feighery,Gina Gregorini,Wolfgang L. Gross,Raashid Luqmani,David Jayne +8 more
TL;DR: The MTX regimen was less effective for induction of remission in patients with extensive disease and pulmonary involvement and was associated with more relapses than the CYC regimen after termination of treatment and the high relapse rates support the practice of continuation of immunosuppressive treatment beyond 12 months.
Journal ArticleDOI
Meta-analysis of the literature or of individual patient data: is there a difference?
Lesley A. Stewart,M.K.B Parmar +1 more
TL;DR: The difference between meta-analysis of the literature (MAL) and meta- analysis of individual patient data (MAP) is investigated by comparing the two approaches using randomised trials of cisplatin-based therapy in ovarian cancer by finding a result of greater statistical significance and an estimate of absolute treatment effect three times as large as the MAP.
Journal ArticleDOI
The Cochrane Collaboration: Preparing, Maintaining, and Disseminating Systematic Reviews of the Effects of Health Care
TL;DR: The Cochrane Collaboration has evolved in response to this challenge and will eventually cover all areas of health care and contributors in many countries and specialties are preparing and maintaining systematic reviews of RCTs, and reviews of other evidence when appropriate.
Journal ArticleDOI
Glucocorticoid Therapy in Giant Cell Arteritis: Duration and Adverse Outcomes
TL;DR: GCs are therapeutically effective in GCA and the prednisone dosage was reduced to physiologic levels in three-fourths of the patients within 1 year, however, most patients developed serious adverse side effects related to GCs, indicating that less toxic therapeutic measures are needed.
Related Papers (5)
A multicenter, randomized, double-blind, placebo-controlled trial of adjuvant methotrexate treatment for giant cell arteritis.
Gary S. Hoffman,Maria C. Cid,David B. Hellmann,Loïc Guillevin,John H. Stone,John T. Schousboe,Pascal Cohen,Leonard H. Calabrese,Howard Dickler,Peter A. Merkel,Paul R. Fortin,John A. Flynn,Geri A. Locker,Kirk A. Easley,Eric S. Schned,Gene G. Hunder,Michael C. Sneller,Carol Tuggle,Howard J. Swanson,J. Hernández-Rodríguez,Alfons López-Soto,Debora Bork,Diane B. Hoffman,Kenneth C. Kalunian,D. J. Klashman,William S. Wilke,Raymond J. Scheetz,Brian F. Mandell,Barri J. Fessler,Gregory S. Kosmorsky,Richard A. Prayson,Raashid Luqmani,George Nuki,Euan McRorie,Yvonne Sherrer,Shawn Baca,Bridgit Walsh,Diane Ferland,Martin Soubrier,Hyon K. Choi,Wolfgang L. Gross,Allen M. Segal,Charles Ludivico,Xavier Puéchal +43 more
The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis
Gene G. Hunder,Gene G. Hunder,Daniel A. Bloch,Daniel A. Bloch,Beat A. Michel,Mary Betty Stevens,Mary Betty Stevens,William P. Arend,William P. Arend,Leonard H. Calabrese,Leonard H. Calabrese,Steven M. Edworthy,Steven M. Edworthy,Anthony S. Fauci,Anthony S. Fauci,Randi Y. Leavitt,J. T. Lie,J. T. Lie,Robert W. Lightfoot,Robert W. Lightfoot,Alfonse T. Masi,Alfonse T. Masi,Dennis J. McShane,Dennis J. McShane,John A. Mills,John A. Mills,Stanley L. Wallace,Stanley L. Wallace,Nathan J. Zvaifler,Nathan J. Zvaifler +29 more