Giant cell arteritis: 20 mg or more of prednisolone was a safer starting dose.

Clinical bottom line (level 4)

  1. Patients with giant cell arteritis who were given 20 mg or more of prednisolone per day, were less likely to need their dose increasing than those given less than 20 mg (NNT = 2 at 40 weeks) .
  2. Patients given 20 mg or more per day had no clear difference in ocular complications.
Myles et al: British Journal of Rheumatology 1992; 31 (2): 103-105
Expires March 2003

The study

Retrospective cohort study with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.
Setting: rheumatology clinic, UK

96 patients (aged ?, ?% male) firm diagnosis of giant cell arteritis (from positive temporal biopsy or four of: scalp tenderness, jaw claudication, recent visual changes, polymyalgia rheumatica, good corticosteroid response)
Control Group: (n = 35, 35 analysed): less than 20 mg prednisolone per day
Experimental Group: (n = 61, 61 analysed): 20 mg prednisolone per day or more

100% followed for 40 weeks

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
dose increase required 40 weeks 16
(45.7%)		 3
(4.92%)		 89.0%
(66.0% to 97.0%)		 40.8%
(23.4% to 58.2%)		 2
(2 to 4)
ocular complications 40 weeks 1
(2.86%)		 5
(8.20%)		 -187%
(-2260% to 65.0%)		 -5.34%
(-14.2% to 3.48%)		 -19
(NNT = 29 to infinity;
NNH = 7 to infinity)

Citation

  1. Myles AB, Perera T, Ridley MG: Prevention of blindness in giant cell arteritis by corticosteroid treatment. British Journal of Rheumatology 1992; 31 (2): 103-105
Contributor: Chris Ball and Clare Wotton, March 2000
Reviewer:

Clinical Question.
Patient giant cell arteritis
Intervention or Exposure 20 mg prednisolone per day or more
Comparison less than 20 mg per day
Outcome ocular complications and dose increase required