Sustained drug-free remission in giant cell arteritis
Authors: Narváez Javier , Domínguez Marta , Galíndez Eva , Mendizábal Javier , Abasolo Lydia , Lluch Judith , Loricera Javier , Garrido Noemí , Castañeda Santos , Moya Patricia , Larena Carmen , Estrada Paula , Galisteo Carlos , Riveros Frutos Anne , Ortiz Sanjuán Francisco , Salman Tarek , Vasques Rocha Margarida , Iñiguez Carlota L , García González María , Blanco Ricardo ,   ARTESER Project Collaborative Group, Morales Clara Moriano , Fernández Ismael González , Álvarez Elvira Díez , Sandoval Trinidad Pérez , Cáceres Vicente Aldasoro , Manteca María Concepción Fito , del Val del Amo Natividad , Rubio Loreto Horcada , Zudaire Inmaculada Paniagua , Courel Laura Garrido , Polo Ricardo Gutiérrez , Vélez Juliana Restrepo , Cortina Eduardo Loza , Martín Julio Sánchez , Carreira Patricia , Almorza Tomás , Mateos Leticia León , Rodríguez Luis Rodríguez , Urgelles Judit Font , Bermejo Pia Mercedes Lois , Gutiérrez Benjamín Fernández , Arrabal Selene Labrada , Casafont Ivette , Pérez Susana Holgado , Camins Jordi , Almela Clara Molina , Fernández Cristina Campos , Cid Amalia Rueda , Catalá Javier Calvo , Rodríguez Iñigo Hernández , Melero Rafael , Maceiras Francisco , Pérez Nair , Barbazán Ceferino , Pego Jose María , Altabás Irene , Guzmán John , Angeles Vanessa Andrea Navarro , Corominas Héctor , Castellví Iván , Magallares Berta , Millán Ana Milena , Villar María Alcalde , Valenciano Ana F Cruz , del Pozo Félix Cabero , Cambrón Ana Belén Rodríguez , Villa Cristina Macia , de Andrés Eva Álvarez , Mas Antonio Juan , Vilamajó Inmaculada Ros , Barceló Monica Ibáñez , Toniolo Elide , Cacheda Ana Paula , Reyes María Sagrario Bustabad , Dorta Alicia García , Hernández Vanesa , Allen Jaime Calvo , Mendieta Eugenio de Miguel , Fernández-Fernández Elisa , Henri Irene Monjo , García Noelia , Martínez Cristina Valero , Vicente Rabaneda Esther F , Porrúa Carlos García , Rivas Noelia Álvarez , Rodríguez Tomás Ramón Vázquez , Filloy Jose Alberto Miranda , Fernández Amalia Sánchez-Andrade , González-Gay Miguel Ángel , Fontova Joan Calvet , Villanueva María Jesús García , Álvarez Patricia Morán , Cabañas Marina Tortosa , Warleta Marta Serrano , Vargas Aliuska Palomeque , Cros Clara Aguilera , Jimenez Alejandro Muñoz , Román Alberto Ruiz , Román Ivorra Jose A , Bárcena Carmen Riesco , Huaylla Anderson , Zorrilla Itziar Calvo , Belzunegui Joaquín María , Valero-Jaimes Jesús A , Domínguez Luis López , Dubuc Cesar Antonio Egues , Silva-Diaz Maite , Fernández Lucia Silva 
Published: November 2024

Abstract

Objetives
The objectives of this study were to evaluate the frequency and timing of sustained drug-free remission (SDFR) in patients with GCA and to identify potential predictive factors of this outcome.

Methods
A retrospective review of all patients included in the large Spanish multicentre registry for GCA (ARTESER) with at least 2 years of follow-up was undertaken. SDFR was defined as the absence of typical signs, symptoms, or other features of active GCA for ≥12 months after discontinuation of treatment.

Results
We included 872 patients. Forty-seven percent had received concomitant treatment with tocilizumab and/or immunosuppressants, mainly MTX. SDFR was achieved in 21.2% (185/872) of the patients. The cumulative rates of patients achieving SDFR at 2, 3 and 4 years were 6.3%, 20.5% and 25.3%, respectively. Patients who achieved SDFR could reduce their prednisone dosage to 10 mg/day (P = 0.090) and 5 mg/day (P = 0.002) more quickly than those who did not. Relapses were less frequent in patients with SDFR (P = 0.006). The presence of relapses [incident rate ratio (IRR): 0.492, P &lt; 0.001] and the need for i.v. methylprednisolone boluses at diagnosis (IRR: 0.575, P = 0.003) were significantly associated with a decreased likelihood of achieving SDFR. Only 5 patients (2.7%) experienced a recurrence, with a median onset of 19 months after achieving SDFR (interquartile range 25th–75th: 14–35 months).

Conclusion
Within 3–4 years of diagnosis, only one-quarter of patients with GCA successfully reached the SDFR. Once the SDFR was achieved, the likelihood of experiencing recurrence was low. Relapses and the need for glucocorticoid boluses appear to have been predictors of the need for long-term glucocorticoids.