Glucocorticoid in giant cell arteritis: real-world treatment patterns over time and associated burden in a nationwide hospital-based study within the French health insurance database.

objectiveRecent advances in giant cell arteritis (GCA) management aim to reduce glucocorticoid (GC). We described changes in treatment patterns over time in real life and assessed associations between cumulative GC use and adverse outcomes.

methodsThis retrospective population-based study used the French national health insurance database (Système National des Données de Santé) and included 18 301 incident GCA cases between 2010 and 2022. Latent class growth modelling identified GC use trajectories. We described trends in cumulative dose and sparing agent use. Multivariable survival models assessed factors associated with sustained GC-free remission and association between GC cumulative exposure and mortality, serious infections, major adverse cardiovascular events (MACE) and osteoporotic fractures.

resultsFour GC use trajectories were identified. Two high-dose trajectories declined over time. Yet, mean 2-year cumulative GC dose remained high, reaching 7.6 g among patients diagnosed in 2022. Methotrexate use increased until 2020 and plateaued thereafter while tocilizumab prescriptions rose, reaching over 25% in 2022. Male sex and baseline methotrexate or tocilizumab use were associated with faster GC tapering, while age >75 years, hypertension, kidney and neurodegenerative diseases were associated with slower tapering. Each gram of GC was associated with higher mortality (HR per gram 1.024, 95% CI 1.021 to 1.027). Yearly cumulative exposure to doses ≤5 mg/day was associated with increased infection (HR 1.13, 95% CI 1.00 to 1.29) and MACE (HR 1.04, 95% CI 1.01 to 1.08).

conclusionDespite reductions in high-dose use, cumulative GC exposure in GCA remains substantial and associated with adverse outcomes, even at the lowest doses.