The following is a summary of “Efficacy and tolerance of methotrexate in a real-life monocentric cohort of patients with giant cell arteritis,” published in the June 2023 issue of the Seminars in Arthritis and Rheumatism by Lavergne et al.

This study aims to evaluate the indications, efficacy, and safety of methotrexate (MTX) in patients with giant cell arteritis (GCA) in a real-world setting. From a monocentric database of >500 GCA patients, 49 patients who received MTX between 2010 and 2020 were retrospectively selected. The number of relapses and GC-related adverse events was recorded before, during, and after MTX cumulative glucocorticoid (GC) doses. 

Researchers analyzed the three significant indications of MTX separately: disease relapse, GC-sparing strategy, and GCA presentation. With a median follow-up of 84 [10–255] months, 25 (51%) and 18/41 (44%) patients, respectively, relapsed during MTX treatment and after its cessation. Among the 40 patients who relapsed before MTX, 26 (65%) relapsed again after the introduction of MTX. 24 (49%) patients were able to discontinue GC after 20.5 [7–64] months once MTX was administered. With a cumulative GC dose of 14.7 [1.05–69.4] grams, there was no significant difference in cumulative GC concentrations before and after MTX introduction. 

At the most recent follow-up, MTX was discontinued in 41 patients, including 13 (32%) because of clinicobiological remission, 12 (30%) because of treatment failure, and 15 (36%) because of adverse effects. Their real-world study demonstrated that MTX has a modestly beneficial effect on relapse in GCA patients. However, no GC-sparing effect was observed in this study. Additional research is required to evaluate the GC-sparing impact in patients whose GC management is modified based on recent recommendations.

Source: sciencedirect.com/science/article/abs/pii/S004901722300032X