Giant Cell Arteritis: Drug Therapy

Therapeutic target

Avoidance of complications

Note: Clinical suspicion of giant cell arteritis is an immediate indication for treatment because of the imminent risk of irreversible visual loss (vision loss)!

Therapy recommendations

  • Steroidal anti-inflammatory therapy (anti-inflammatory therapy with glucocorticoids):
  • After initial therapy: reduction by 10 mg/week (up to 30 mg); if < 30 mg/d, then reduction by 2.5 mg/d (down to 10 mg); if < 10 mg/d, then reduction by 1 mg/month (minimum duration of therapy of approximately 2 years).
  • Initial high-dose intravenous methyprednisolone therapy is recommended for patients with cerebral (“brain-related”) or ocular (“eye-related”) symptomatology.
  • Methotrexate – 15-25 mg/week; lead to a lower steroid dose and decrease the relapse rate (recurrence of the disease); in case of contraindications (contraindications): alternatively: azathioprine (immunosuppressants/drugs that reduce the functions of the immune system) – 150 mg/d; decrease the steroid dose.
  • Additive therapy:

Further notes

  • Dose reduction of prednisone should be accompanied by controls of inflammatory parameters inflammatory parameters (ESR and CRP). However, clinical response is paramount; laboratory parameters are for confirmation only.
  • In off-label use (prescription of a finished drug outside the use approved by the drug authorities) methotrexate (MTX) is used.
  • Biologicals are currently used only in trials: The monoclonal antibody tocilizumab, which blocks the receptor of interleukin-6 (IL-6), reduced glucocorticoid requirements in a phase III trial in patients with giant cell arteritis.Tocilizumab has been approved for the treatment of RZA since 2019.
  • Administration of tocilizumab or MTX reduces glucocorticoid requirements and the risk of recurrence (risk of disease recurrence) in the long term compared with glucocorticoid monotherapy.