Giant cell arteritis: high dose steroids were not clearly better than low dose.

Clinical bottom line (level 1b-)

  1. Patients with giant cell arteritis who were given low dose steroids, had no clear difference in treatment failure than those given high dose.
  2. Patients with polymyalgia rheumatica who were given low dose steroids were more likely to have treatment failure than those given high dose (NNT = 2 at unknown) .
  3. In patients with either GCA or PMR, high dose steroids decreased treatment failure (NNT = 3 at unknown) .
Kyle and Hazleman: Annals of the Rheumatic Diseases 1989; 48: 658-661
Expires November 2004

The study

?blinded ?concealed randomised trial ?with intention-to-treat
Setting: general hospital, UK

74 patients (aged ?, ?% male) active untreated polymyalgia rheumatica (PMR)(n=39) or giant cell arteritis (GCA)(n=35)
Control Group: (n = 35, 35 analysed): low dose steroids: PMR 10 mg/ day; GCA 20 mg/day. 20 patients with PMR; 15 with GCA
Experimental Group: (n = 39, 39 analysed): high dose steroids: PMR 15-20 mg/ day; GCA 40 mg/day. 19 patients with PMR; 20 with GCA
If the disease process did not appear to be controlled or if new symptoms developed the prednisolone dose was altered to achieve adequate control.
100% followed for ?
Outcome notes:
  • treatment failure : increase from the planned prednisolone dose or inability to reduce the prednisolone dose as planned

The evidence

patients with GCA
Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
treatment failure weeks 6
(40.0%)		 4
(20.0%)		 50%
(-46% to 83%)		 20.0%
(-10.4% to 50.4%)		 5
(NNT = 2 to infinity;
NNH = 10 to infinity)

patients with PMR
Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
treatment failure unknown 13
(65.0%)		 2
(10.5%)		 84%
(38% to 96%)		 54.5%
(29.4% to 79.5%)		 2
(1 to 3)

patients with GCA or PMR
Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
treatment failure unknown 19
(54.3%)		 6
(15.4%)		 72%
(37% to 87%)		 38.9%
(18.9% to 58.9%)		 3
(2 to 5)

Citation

  1. Kyle V, and Hazleman BL: Treatment of polymyalgia rheumatica and giant cell arteritis. I. Steroid regimens in the first two months. Annals of the Rheumatic Diseases 1989; 48: 658-661
Contributor: Clare Wotton and Bob Phillips, November 2000
Reviewer:

Clinical Question.
Patient GCA or PMR
Intervention or Exposure high dose steroids
Comparison low dose steroids
Outcome requiring increased dose