Glucocorticoid Exposure in Giant Cell Arteritis

A NATIONWIDE French health insurance database study has revealed that glucocorticoid use in giant cell arteritis remains substantial despite treatment advances, with cumulative exposure linked to higher mortality, serious infections, and major cardiovascular events, even at the lowest daily doses.

Reducing Glucocorticoid Reliance in Giant Cell Arteritis

Glucocorticoid therapy has remained the cornerstone of giant cell arteritis management despite substantial toxicity, particularly among older patients. Glucocorticoid-sparing agents such as methotrexate and tocilizumab have become more widely available in recent years, raising hopes that cumulative glucocorticoid exposure in giant cell arteritis could be reduced, although real-world evidence remained limited.

Population-Based Study Using French Insurance Data

Researchers conducted a retrospective, population-based study using the French national health insurance database, identifying 18,301 incident cases of giant cell arteritis diagnosed between 2010 and 2022. Latent class growth modelling identified four glucocorticoid use trajectories over a 2-year follow-up period, and multivariable survival models assessed factors associated with sustained glucocorticoid-free remission and with mortality, serious infections, major adverse cardiovascular events, and osteoporotic fractures. Baseline demographic details were not provided.

Cumulative Glucocorticoid Exposure Linked to Adverse Outcomes

Four glucocorticoid use trajectories were identified; two high-dose trajectories declined over time, yet mean 2-year cumulative dose remained high, reaching 7.6 g in patients diagnosed in 2022. Methotrexate use increased until 2020 before plateauing, while tocilizumab prescriptions rose to over 25% by 2022. Male sex and baseline methotrexate or tocilizumab use were linked to faster glucocorticoid tapering, while older age, hypertension, kidney disease, and neurodegenerative disease were linked to slower tapering. Each additional gram of glucocorticoid exposure was associated with higher mortality (hazard ratio [HR] per gram 1.024, 95% CI 1.021 to 1.027), and yearly exposure to doses of 5 mg per day or less was associated with increased serious infection (HR 1.13, 95% CI 1.00 to 1.29) and major adverse cardiovascular events (HR 1.04, 95% CI 1.01 to 1.08). P values for these hazard ratios were not reported in the source data.

Implications for Long-Term Steroid-Sparing Strategies

These findings suggest that despite reductions in high-dose regimens, cumulative glucocorticoid exposure in giant cell arteritis remains substantial and is linked to adverse outcomes even at low doses. As this was an observational study, causality could not be confirmed. Greater efforts to limit glucocorticoid exposure, particularly in high-risk patients, and wider use of glucocorticoid-sparing agents were suggested.

Reference

Beydon M et al. Glucocorticoid in giant cell arteritis: real-world treatment patterns over time and associated burden in a nationwide hospital-based study within the French health insurance database. RMD Open. 2026;12:e006866.

Featured image: Bernard Chantal on Adobe Stock