Corticosteroid therapy in GCA: higher platelets – lower relapse rate

An increased platelet count and a GLCCI1 gene polymorphism were shown to be associated with a lower relapse rate in patients with giant cell arteritis (GCA) treated with corticosteroids [1].

Corticosteroids are the cornerstone in the management of GCA, the most common cause of primary vasculitis in adults. However, approximately half of the patients will relapse, and up to 86% develop steroid-induced adverse events. In this study, risk factors for relapse in GCA patients treated with prednisolone were assessed.

All included patients were steroid-naïve with a diagnosis of GCA. Patients received steroids, with a 10 to 16 months predefined tapering schedule and a planned follow-up of 18 months after inclusion. Genotyping of glucocorticoid-induced transcript 1 (GLCCI1) promoter polymorphism (rs37972), which regulates steroid-induced apoptosis, and prednisolone clearance were performed between 14 and 28 days of treatment.

Among the 119 patients included, 37 (31%) had polymyalgia rheumatica and 59 (49.6%) patients had at least one relapse. The mean prednisolone clearance was 7.2 ± 6.7 L/h. For each increase of 1 unit of prednisolone clearance, the relapse risk increased by 2.6%, although not significantly, in univariate analysis. On multivariate analysis, only platelets were associated with a decreased risk of relapse (decrease by 2% for each increase of 10,000 platelets/mm3). Additionally, among the 121 patients who had a determination of the GLCCI1 promoter polymorphism, it was shown that patients with a CC genotype had a lower risk of relapse. The authors concluded that both a higher platelet count and a CC promoter polymorphism are associated with a decreased risk of relapse. Further studies should determine whether these patients should be treated with a steroid-sparing regime.

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   1.  Deshayes S, et al. Abstract L16. ACR 2019, 9-13 November, Atlanta (GA/USA).

Posted on 4 February, 202012 March, 2021