Serious adverse effects associated with glucocorticoid therapy in patients with giant cell arteritis (GCA): A nested case–control analysis

Wilson, J. K.; Sarsour, Khaled; Collinson, Neil; Tuckwell, Katie; Musselman, David; Klearman, Micki; Napalkov, Pavel; Jick, Susan S.; Stone, John H.; Meier, Christoph

doi:10.1016/j.semarthrit.2016.11.006

Cited by 81 publications

(67 citation statements)

References 32 publications

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“…The trend in increased rates of potential OGC-related AEs with increasing cumulative OGC exposure in patients with GCA is consistent with previous findings from US healthcare claims databases and the UK Clinical Practice Research Datalink. 9,12,14 Prior studies have reported the association between the initial dose of prednisone and rates of AEs in patients with GCA. 19,20 Our study adds to the evidence of the association between cumulative steroid dose and increased steroid-related AEs in patients with GCA.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11] Chronic GC exposure is associated with increased risk of adverse effects and comorbidities in patients with GCA, including infections, osteoporosis, fractures, cataract, glaucoma, and diabetes. 9,[11][12][13][14] Increased cumulative GC dose in patients with GCA has been shown to be associated with an increased risk of GC-related adverse events (AEs). 12 A similar association between cumulative GC exposure and burden of GC-related AEs and comorbidities also exists in patients with rheumatoid arthritis.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Healthcare Costs of Potential Glucocorticoid-Associated Adverse Events in Patients with Giant Cell Arteritis</p>

Best¹,

Kong

Smith

et al. 2019

CEOR

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Objective: To quantify the healthcare expenditures associated with potential oral glucocorticoid (OGC)-related adverse events (AEs) in patients with giant cell arteritis (GCA). Methods: Patients with GCA and ≥ 1 OGC prescription fill between 2009 and 2014 were identified from the MarketScan Commercial and Medicare Supplemental claims databases. Patients were stratified into four groups based on cumulative OGC dose (> 0 to ≤ 2607 mg, > 2607 to ≤ 4800 mg, > 4800 to ≤ 7200 mg, and > 7200 mg) during the 1-year follow-up period; incidence of potential AEs and AE-related direct healthcare costs in USD were assessed. Association between the log of cumulative OGC dose and AE-related direct healthcare costs was evaluated, adjusting for baseline characteristics. Results: Of 1602 patients with GCA included, 69% were women; the mean age was 73 years. The mean cumulative OGC dose was 5806 mg during the 1-year follow-up; most exposure occurred in the first 6 months. The proportion of patients with potential OGC-related AEs was 36.5% overall and increased as cumulative dose increased (30.7%-45.3% across dose groups). Unadjusted mean AE-related costs for patients with an AE was USD $12,818. In the multivariable model including all patients, increasing OGC dose was associated with increasing AE-related healthcare costs (cost ratio, 1.38 [95% CI, 1.16-1.64] per 1-unit increase in log of cumulative OGC dose [P < 0.001]). Mean (median)-predicted AE costs for the dose groups were USD $4389 ($2749) for > 0 to ≤ 2607 mg, USD $5176 ($3009) for > 2607 to ≤ 4800 mg, USD $5576 ($3633) for > 4800 to ≤ 7200 mg, and USD $6609 ($4447) for > 7200 mg. Conclusion:In patients with GCA, OGC-related AEs increased with increasing cumulative OGC dose, resulting in increased healthcare costs. These results highlight the need for efficacious therapies that reduce the exposure to and potential risks associated with OGCs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Healthcare Costs of Potential Glucocorticoid-Associated Adverse Events in Patients with Giant Cell Arteritis</p>

Best¹,

Kong

Smith

et al. 2019

CEOR

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“…Innerhalb von 10 Jahren entwickeln 86 % der behandelten RZA-Patienten GC-Nebenwirkungen [6 -9]. Das Nebenwirkungsrisiko hängt erwartungsgemäß von Dauer und Dosis der GC-Therapie ab [6]. Zahlreiche Untersuchungen bringen eine ungünstige Gesamtprognose mit der Aneurysmabildung in Verbindung.…”

Section: Verlauf Und Prognoseunclassified

Aktuelle Optionen zur Behandlung der Riesenzellarteriitis

Moosig¹,

Schmalzing²,

Aries³

et al. 2019

Dtsch med Wochenschr

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Um potenziell schwere Komplikationen zu vermeiden, muss bei Patienten mit Riesenzellarteriitis (RZA) zügig eine Behandlung eingeleitet werden. Bisher waren meist langfristig verabreichte Glukokortikoide (GC) die Standardbehandlung. Damit lässt sich die Erkrankung häufig jedoch nur unzureichend kontrollieren, zudem besteht das Risiko GC-induzierter Langzeitschäden. Daher stehen steroidsparende Therapieoptionen im Mittelpunkt des Interesses. EinleitungDie Riesenzellarteriitis (RZA) ist in Europa die häufigste Großgefäßvaskulitis und galt bis dato, mit der Gabe von Glukokortikoiden (GC), als einfach zu behandeln. Aktuelle Daten zeigen jedoch, dass die GC-Therapie oft über mehr als 2 Jahre und in kumulativ hohen Dosierungen erfolgt. Zudem sind Rezidive bei Dosisreduktion oder nach Therapieende häufig, sodass eine potente GC-sparende Therapie wünschenswert ist. Anlässlich der neuen Therapieoptionen stellt diese Übersichtsarbeit den aktuellen Kenntnisstand zur RZA-Therapie dar.

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“…A nested case–control analysis of a large database from the UK of 5011 patients with GCA showed a dose‐dependent increase in the risk of steroid adverse effects (diabetes and osteoporosis) with higher cumulative dose of oral prednisolone. There was also increased risk of diabetes, fractures, glaucoma, serious infections and death with higher average daily dose of prednisolone compared to doses below 10 mg daily . The early addition of bone protection with calcium, vitamin D and anti‐osteoporotic therapies according to local guidelines is recommended.…”

Section: Advances In Therapymentioning

confidence: 99%

“…There was also increased risk of diabetes, fractures, glaucoma, serious infections and death with higher average daily dose of prednisolone compared to doses below 10 mg daily. 87 The early addition of bone protection with calcium, vitamin D and anti-osteoporotic therapies according to local guidelines is recommended.…”

Section: Glucocorticoid Regimens and Deliverymentioning

confidence: 99%

Giant cell arteritis: beyond temporal artery biopsy and steroids

Ninan

Lester

Hill

2017

Internal Medicine Journal

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Giant cell arteritis is the most common primary vasculitis of the elderly. The acute complications of untreated giant cell arteritis, such as vision loss or occasionally stroke, can be devastating. The diagnosis is, however, not altogether straightforward due to variable sensitivities of the temporal artery biopsy as a reference diagnostic test. In this review, we discuss the increasing role of imaging in the diagnosis of giant cell arteritis. Glucocorticoid treatment is the backbone of therapy, but it is associated with significant adverse effects. A less toxic alternative is required. Conventional and novel immunosuppressive agents have only demonstrated modest effects in a subgroup of steroid refractory Giant cell arteritis due to the different arms of the immune system at play. However, recently a study of interleukin-6 blockade demonstrated benefits of giant cell arteritis. The current status of these immunosuppressive agents and novel therapies are also discussed in this review.

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Serious adverse effects associated with glucocorticoid therapy in patients with giant cell arteritis (GCA): A nested case–control analysis

Cited by 81 publications

References 32 publications

<p>Healthcare Costs of Potential Glucocorticoid-Associated Adverse Events in Patients with Giant Cell Arteritis</p>

<p>Healthcare Costs of Potential Glucocorticoid-Associated Adverse Events in Patients with Giant Cell Arteritis</p>

Aktuelle Optionen zur Behandlung der Riesenzellarteriitis

Giant cell arteritis: beyond temporal artery biopsy and steroids

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