Decrease in Giant Cell Arteritis Relapse Risk With Elevated Platelet Count, CC Promoter Polymorphism

The following article is a part of conference coverage from the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, being held in Atlanta, Georgia. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the 2019 ACR/ARP Annual Meeting.

ATLANTA — Both higher platelet count and the presence of a CC promoter polymorphism (rs37972) were associated with a decreased risk for relapse in patients with giant cell arteritis, according to research results presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, held November 8 to 13, 2019, in Atlanta, Georgia.

Researchers conducted a multicenter, prospective study (PREDICORT; ClinicalTrials.gov Identifier: NCT01400464) of steroid-naive patients with a diagnosis of giant cell arteritis to examine risk factors for relapse, including both prednisone clearance and glucocorticoid-induced transcript 1 (GLCCI1) rs37972.

Patients received steroids on a 10- to 16-month predefined taper schedule; follow-up was planned for 18 months after inclusion. GLCCI1 rs37972 genotyping and prednisone clearance were conducted between 14 and 28 days of treatment.

The study cohort included 119 patients (70 women; mean age, 72.2±7.6 years; median follow-up duration, 74 months). Within the cohort, 37 (31%) had polymyalgia rheumatica; the median C-reactive protein level and sedimentation rate were 78 mg/L (range, 13-102 mg/L) and 70 mm/h (range, 35-94 mm/h), respectively, with 59 (49.6%) patients experiencing at least 1 relapse.

Mean prednisone clearance was 7.2±6.7 L/h. Relapse risk increased for each 1 unit of clearance by 2.6%, which the researchers deemed nonsignificant (hazard ratio [HR], 1.026; 95% CI, 0.99-1.06). In a multivariate analysis, only platelets were associated with a decreased relapse risk (HR, 0.98; 95% CI, 0.96-0.9997 for each increase of 10,000 platelets/mm³).

Results of an ancillary study in 121 patients with a determination of GLCCI1 rs37972 polymorphism indicated that patients with a CC genotype experienced fewer relapses than those with at least 1 T allele.

“To our knowledge this study is the largest prospective study including steroid-naive [patients with giant cell arteritis] treated with uniform predefined taper schedule, and the first one assessing prednisone clearance as a risk factor for relapse,” the researchers concluded. “Further studies are needed to determine the effect of a steroid-tapering treatment as a first-line treatment in association with steroids in patients with the CT or TT rs37972 polymorphism.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Deshayes S, Bourdin V, Creveuil C, et al. GLCCI1 polymorphism is associated with prednisone response in giant cell arteritis: a multicenter prospective study. Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. Abstract L16.