Glucocorticoid therapy in giant cell arteritis: Duration and adverse outcomes
Glucocorticoid therapy in giant cell arteritis: Duration and adverse outcomes
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DOI：
10.1002/art.11388
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发表时间：
2003-10-15
期刊：
影响因子：
--
通讯作者：
Hunder, GG
中科院分区：
文献类型：
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作者：
Proven, A;Gabriel, SE;Hunder, GG
Objective.评价糖皮质激素（GC）治疗巨细胞动脉炎（GCA）患者的疗程及相关不良事件。我们确定了125名奥姆斯特德县居民与GCA诊断1950年至1991年之间，并获得了120名患者的死亡前诊断，并同意参加这项研究的后续信息。记录每例患者的临床变量、GC剂量和GC不良事件。采用考克斯和Anderson-Gill比例风险模型分析GC治疗与不良事件发生的关系。所有患者均接受GC治疗并迅速缓解（中位初始剂量60 mg泼尼松/天）。随后根据主治医生的判断减少剂量。达到7.5 mg/天所需的中位持续时间为6.5个月，达到5 mg/天所需的中位持续时间为7.5个月。复发或复发57例。对于87例终止GC治疗和GCA永久缓解（中位数为22个月）的患者，泼尼松的总中位数剂量为6.47 gm。103例（86%）患者记录了与GC相关的不良事件，70例（58%）患者发生了2起或2起以上事件。年龄和较高的GC累积剂量与GC不良副作用的发生相关。GC在GCA中是治疗有效的，并且在1年内四分之三的患者中泼尼松剂量减少到生理水平。然而，大多数患者发生了与GC相关的严重不良副作用，表明需要毒性较小的治疗措施。
Objective. To evaluate the course of glucocorticoid (GC) therapy and associated adverse events in a population-based cohort of patients with giant cell arteritis (GCA).Methods. We identified 125 Olmsted County residents with GCA diagnosed between 1950 and 1991 and obtained followup information on the 120 patients who were diagnosed antemortem and agreed to participate in this study. Clinical variables, GC doses, and GC adverse events on each patient were recorded. The relationship between GC therapy and the development of adverse events was studied by the Cox and Anderson-Gill proportional hazards models.Results. All patients were treated with GCs and responded rapidly (median initial dosage 60 mg prednisone/day). The dosage was later reduced according to the treating physicians' judgment. The median duration required to reach 7.5 mg/day was 6.5 months and the median duration required to reach 5 mg/day was 7.5 months. Relapses or recurrences occurred in 57 patients. For the 87 patients followed to discontinuation of GC therapy and permanent remission of GCA (median of 22 months), the total median dose of prednisone was 6.47 gm. Adverse events associated with GCs were recorded in 103 (86%) patients and 2 or more events occurred in 70 patients (58%). Age and higher cumulative dose of GCs were associated with the development of adverse GC side effects.Conclusion. GCs are therapeutically effective in GCA and the prednisone dosage was reduced to physiologic levels in three-fourths of the patients within 1 year. However, most patients developed serious adverse side effects related to GCs, indicating that less toxic therapeutic measures are needed.