Predictors of relapse and treatment outcomes in biopsy-proven giant cell arteritis: a retrospective cohort study

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dc.contributor.authorLabarca, Cristian
dc.contributor.authorKoster, Matthew
dc.contributor.authorCrowson, Cynthia
dc.contributor.authorMakol, Ashima
dc.contributor.authorYtterberg, Steven
dc.contributor.authorMatteson, Eric
dc.contributor.authorWarrington, Kenneth
dc.date.accessioned2017-05-15T16:38:04Z
dc.date.available2017-05-15T16:38:04Z
dc.date.issued2016
dc.description.abstractOBJECTIVE: To evaluate characteristics of relapse, relapse rates, treatment and outcomes among patients with biopsy-proven GCA in a large, single-institution cohort. METHODS: We conducted a retrospective review of all patients with biopsy-proven GCA from 1998 to 2013. Demographic, clinical, laboratory and treatment data at presentation and during follow-up were collected. Comparisons by relapse rate were performed using chi-square tests. Prednisone discontinuation by initial oral dose ≤40 and >40 mg/day was compared using Cox models. RESULTS: The cohort included 286 patients [74% female, mean age at diagnosis 75.0 years (s.d. 7.6), median follow-up 5.1 years). During follow-up, 73 patients did not relapse, 80 patients had one relapse and 133 had two or more relapses. The first relapse occurred during the first year in 50% of patients, by 2 years in 68% and by 5 years in 79%. More patients with established hypertension (P = 0.007) and diabetes (P = 0.039) at GCA diagnosis were in the high relapse rate group ( ≥ 0.5 relapses/year) and more females were in the low or high relapse groups than in the no relapse group (P = 0.034). Patients receiving an initial oral prednisone dose >40 mg/day were able to reach a dose of <5 mg/day [hazard ratio (HR) 1.46 (95% CI 1.09, 1.96)] and discontinue prednisone [HR 1.56 (95% CI 1.09, 2.23)] sooner than patients receiving ≤40 mg/day without an increase in observed glucocorticoid-associated adverse events. CONCLUSION: Females and patients with hypertension or diabetes at GCA diagnosis have more relapses during follow-up. Patients treated with an initial oral prednisone dose >40 mg/day achieved earlier prednisone discontinuation.
dc.format.extent10
dc.identifier.citationLabarca C, Koster MJ, Crowson CS, Makol A, Ytterberg SR, Matteson EL, Warrington KJ. Predictors of relapse and treatment outcomes in biopsy-proven giant cell arteritis: a retrospective cohort study. Rheumatology (Oxford). 2016 Feb;55(2):347-56.
dc.identifier.urihttp://hdl.handle.net/11447/1249
dc.identifier.urihttp://dx.doi.org/10.1093/rheumatology/kev348
dc.language.isoen_US
dc.publisherOxford University Press
dc.subjectadverse events
dc.subjectcohort
dc.subjectdiabetes
dc.subjectgiant cell arteritis
dc.subjectglucocorticoids
dc.subjecthypertension
dc.subjectrelapse
dc.subjectretrospective
dc.titlePredictors of relapse and treatment outcomes in biopsy-proven giant cell arteritis: a retrospective cohort study
dc.typeArtículo

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