A study published by Florence Tubach and colleagues indicated that cumulative glucocorticoid exposure increased the risks of death, serious infection, cardiovascular events, and fractures in giant cell arteritis (GCA) patients in France. The study, conducted between 2010 and 2022, analyzed glucocorticoid usage patterns among 18,301 GCA patients.

The research found that each gram of cumulative prednisone equivalent dose increased the risk of death by 2.4%. For serious infections, each 1-gram increment in cumulative dose was associated with a hazard ratio of 1.050. Major adverse cardiovascular events (MACE) had a hazard ratio of 1.015 for each 1-gram increment in cumulative dose, and major osteoporotic fractures showed a hazard ratio of 1.013 for each 1-gram increment.

Even at lower doses, measurable harm was reported. Among patients receiving an annual average of 5 mg/day or less in prednisone equivalents, the infection risk increased by 13% compared with patients with no glucocorticoid exposure. The risk for MACE in this same low-dose group rose by 4%. Dr. Florence Tubach stated, "Our findings highlight that the burden associated with cumulative GC [glucocorticoid] exposure remains important, and that even low GC doses do not appear to be safe." She added, "Overall, our work underscores the need for continuous and accelerated efforts to reduce GC use in GCA."

The study detailed that the mean age of patients was 75 years, and approximately two-thirds were women. One-quarter of the patients also had polymyalgia rheumatica. Thirty percent of the overall patient group died during the follow-up period. For patients newly diagnosed in 2022 and followed for two years, the cumulative mean dose was 7.6 grams in prednisone equivalents.

About 15% of patients were initially started on high doses of glucocorticoids, defined as 60 mg/day or higher. By the sixth month, two-thirds of these patients had their mean daily dose tapered to less than 10 mg/day. The percentage of patients prescribed high-dose regimens decreased from nearly 20% in 2010 to approximately 10% in 2022. Within the first two years, 34% of patients achieved complete glucocorticoid withdrawal, a figure that reached 73% by year five. However, only 8% of patients starting a high-dose, slow-taper regimen achieved complete glucocorticoid withdrawal within the initial two years.

By year five, 81% of patients had experienced at least six months of glucocorticoid-free disease remission. Patients who were women, 75 years or older, or had neurocognitive disorders, hypertension, or chronic kidney disease were less likely to achieve glucocorticoid-free remission. A 10-mg/day increase in the initial glucocorticoid dose was linked to a 1% decrease in the likelihood of achieving glucocorticoid-free remission. Starting methotrexate at diagnosis improved the probability of glucocorticoid-free remission by 22%, while starting tocilizumab improved it by 39%. By 2022, fewer than 30% of patients were receiving methotrexate or tocilizumab three years after diagnosis.