A recent population-based study assessed the use of intravenous methylprednisolone for the treatment of giant cell arteritis and examined its effects on visual outcomes, comorbidities, and mortality.
This retrospective study analyzed data from 419 patients in Sweden with biopsy-confirmed giant cell arteritis (GCA) over a 15-year period, comparing those treated with intravenous methylprednisolone (IVMP) against those receiving only oral glucocorticoids (OGC). Up to half of people with GCA experience ocular involvement with different levels of vision impairment and occurrences of diplopia, amaurosis fugax and eye pain, the researchers noted in the study published in Rheumatology. The treatment recommendations for patients experiencing visual complications call for use of IVMP prior to starting OGCs, and the researchers noted an unreplicated study that showed this protocol was superior to OGC-only treatment.
In the new study, the IVMP group received an average of three doses of IVMP (500–1000 mg) during the initial treatment phase, followed by a transition to OGCs. The cumulative glucocorticoid dose was higher in the IVMP group over the first year. Over a mean follow-up of 6.6 years, no significant differences were observed between groups regarding overall survival or rates of other comorbidities, including ischemic heart disease and severe infections.
Visual symptoms in GCA patients were most frequently reported before the initiation of IVMP. Among 90 patients with confirmed ischemic visual involvement, IVMP did not significantly improve visual acuity (VA) outcomes compared to OGC alone. Only 20% of patients on IVMP showed meaningful VA improvement, with no statistical difference from the OGC group.
In a subgroup analysis, patients over 80 years old had a higher incidence of adverse effects, particularly hyperglycemia, when treated with IVMP. Patients receiving IVMP were also at a higher risk of developing new-onset diabetes mellitus within the first year of diagnosis (11.7% for IVMP vs. 4.9% for OGC). The odds ratio for developing diabetes was 2.59, which increased to 3.30 after adjusting for factors such as cumulative glucocorticoid dose.
The investigators noted that “the nongenomic effect [one of the mechanisms that mediates the effects of glucocorticoids] is greater in patients receiving high-dose IVMP compared with OGC only, providing a rationale for intravenous treatment in patients at risk of complications.” However, they “found no evidence of a beneficial effect in improving visual acuity or enabling more rapid tapering of the oral glucocorticoid dose.”
The authors declared no conflicts of interest.
