Giant cell arteritis: alternate day steroids were less effective but had fewer side effects.

Clinical bottom line (level 1b)

  1. Patients with giant cell arteritis who were given alternate days steroid regimens, were more likely to have unresolved symptoms, than those given daily steroids (NNH = 2 at 4 weeks) .
  2. Patients given alternate day steroid regimens were less likely to have steroid adverse effects (NNT = 2 at 8 weeks) .
Hunder et al: Annals of Internal Medicine 1975; 82 (5): 613-618
Expires February 2004

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: rheumatology unit, USA

60 patients (aged range 51 to 83 years; mean 68, 80% female) biopsy-proven giant cell arteritis, started on steroids
Control Group: (n = 40, 40 analysed): prednisone 15 mg every 8 hours, or 45 mg po od
Experimental Group: (n = 20, 20 analysed): prednisone 90 mg po on alternate days

100% followed for 8 months

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
symptoms unresolved 4 weeks 6
(15.0%)		 14
(70.0%)		 -367%
(-930% to -111%)		 -55.0%
(-77.9% to -32.1%)		 -2
(-1 to -3)
adverse steroid effects 8 weeks 26
(65.0%)		 0
(0.00%)		 100%
(% to %)		 65.0%
(50.2% to 79.8%)		 2
(1 to 2)

Comments

  1. There was no significant difference between 15 mg tds and 45 mg od groups- so results were combined.

Citation

  1. Hunder EG, Sheps SG, Allen GL, et al: Alternate day corticosteroid regimens in the treatment of giant cell arteritis: comparison in a prospective study. Annals of Internal Medicine 1975; 82 (5): 613-618
Contributor: Chris Ball and Clare Wotton, February 2000
Reviewer:

Clinical Question.
Patient giant cell arteritis
Intervention or Exposure high prednisone on alternate days
Comparison low dose prednisone once daily
Outcome no resolution of symptoms and side effects