The Great Debate 2023

Dr. Seo also argued that clinicians may tend to underestimate the risks of glucocorticoid therapy, even at lower doses. He cited an analysis showing that patients taking very low-dose glucocorticoids had increased risks of myocardial infarction and other cardiac events.¹² Moreover, low-dose glucocorticoids can induce white matter changes in the brain that correlate with decreased cognitive function, as well as contribute to such risks as increased HbA1C, cataracts, weight gain and osteoporosis.

Bottom Line

Although they debated some of the finer points of interpretation of current studies, the two panelists agreed much more than they disagreed. Starting IL-6 inhibition in patients with new-onset GCA or PMR is a reasonable approach for many patients, especially for those at higher risk of serious glucocorticoid toxicities.

On the other hand, initial steroid-only therapy is also a valid approach, depending on the medical context. If they do opt for initial steroid-only treatment, clinicians should be vigilant about prescribing the lowest effective dose of glucocorticoids for the minimal time needed, escalating to anti IL-6 therapies promptly at signs of refractory or relapsed disease.

Ruth Jessen Hickman, MD, is a graduate of the Indiana University School of Medicine. She is a freelance medical and science writer living in Bloomington, Ind.

References

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