A new study offers both hope and a practical treatment option for patients with giant cell arteritis (GCA). Researchers from Emory University and the Mayo Clinic have found that by treating newly diagnosed GCA patients with just three days of a high-dose intravenous steroid, patients relapsed less in the following year and were able to significantly taper off usage of an oral steroid. The study is published in the October issue of the journal Arthritis & Rheumatism.
Giant cell arteritis is characterized by inflammation of arteries, primarily in the head, and affects 20 out of every 100,000 people. GCA inflammation may lead to swelling and headaches, or, as it progresses, vision loss, strokes and aortic aneurysms. While past research has shown a genetic link to the disease, which primarily affects Caucasian women over the age of 50, there is no known cause or cure.
For the last 40 years, physicians have been able to treat and reverse some symptoms of GCA by prescribing prednisone, to be taken daily over a year or more. "Patients improve promptly and reliably, within days of when we treat them," says Cornelia M. Weyand, MD, PhD, co-director of the Kathleen B. and Mason I. Lowance Center for Human Immunology at Emory University and an author of the paper. "The problem is that patients have to take prednisone for a long time and in high doses, and they are at risk of developing side effects." Common side effects include hypertension, diabetes and osteoporosis.
While scientists have attempted to develop new drugs that would be more effective and have fewer side effects, their results have been unsuccessful. "We and others tried to look into other types of treatments that could help with this disease," says Jorg Goronzy, MD, PhD, senior author of the paper, and co-director of the Lowance Center.
"Even the modern and effective immunosuppressants do not improve the situation with these patients," says Dr. Weyand.
Faced with these ineffective new agents and with the limitations and drawbacks of the current treatment, Dr. Goronzy and Dr. Weyand turned to animal models. After implanting inflamed arteries into mice, they observed the effect of different doses of steroids on the inflammation. "We learned that the doses of steroids, although already high, really didn't take away the disease," says Dr. Weyand. "But if we increased the dose to very high levels, we could then eradicate the inflammation."
Equipped with those initial results, they designed a double-blind human study to examine whether a brief period of pulsing with high-dose intravenous steroids soon after diagnosis could reduce the long-term need for prednisone and improve patient recovery.
As the article and an accompanying editorial report, the research showed extremely positive long-term results. Those patients who had been given the initial high dosage had fewer relapses of the disease (21, as compared to 37 relapses). Seventy-one percent were also able to reduce their daily dose of prednisone to 5 milligrams after a year of treatment (compared to only 15 percent in the control group), avoiding the need for long-term steroids.
The results will be good news at Emory's new Vasculitis Clinic, the only center for inflammatory blood vessel diseases in the Southeast. "We can do better in treating this disease, and what we do at the beginning is very important for the long-term prognosis of patients," says Dr. Weyand.
Mehrdad Mazlumzadeh of the Mayo Clinic in Scottsdale, Ariz., was first author of the paper. The research was funded by the National Institutes of Health, the Dana Foundation, the Mayo Foundation and the National Institutes of Health General Clinical Research Center.