TY - JOUR T1 - Methotrexate in Giant Cell Arteritis Deserves a Second Chance — A High-dose Methotrexate Trial Is Needed JF - The Journal of Rheumatology JO - J Rheumatol SP - 453 LP - 454 DO - 10.3899/jrheum.181306 VL - 46 IS - 5 AU - ELISABETH BROUWER AU - KORNELIS S.M. VAN DER GEEST AU - MARIA SANDOVICI Y1 - 2019/05/01 UR - http://www.jrheum.org/content/46/5/453.abstract N2 - Giant cell arteritis (GCA) is a chronic inflammatory disease of the large- to medium-sized arteries and shows a relapsing course in up to 75% of patients. In sharp contrast to other autoimmune/inflammatory diseases, the treatment of GCA still heavily relies on high-dose, longterm glucocorticoids (GC)1. After 5 years of GC treatment, > 50% of patients still have active disease and are continuing the treatment. The well-known side effects of GC add to the burden of the disease itself, decreasing the quality of life of these elderly patients with GCA.Are there good alternatives for GC in the treatment of GCA? Recently, a successful randomized controlled trial (RCT) was performed with the interleukin (IL-) 6 receptor blocker tocilizumab (TCZ) in GCA. More than 50% of the treated patients reached the primary endpoint of the study and were in sustained GC-free remission at 1 year2.Although TCZ is an important addition to the therapeutic tools against GCA, there are also several drawbacks. First, almost 50% of patients still develop a relapse despite TCZ. Second, under treatment with TCZ, one cannot rely on the acute-phase reactants as biomarkers of disease activity in GCA. Currently there are no IL-6–independent validated biomarkers for routine use in GCA. Also, as with other new treatments with potential therapeutic effect in GCA, the costs of TCZ are significant. In contrast to the upcoming trials with new, expensive treatment modalities in GCA (upadacitinib NCT03725202, ustekinumab NCT03711448, NCT02955147, sarilumab NCT03600805, baricitinib NCT03026504, granulocyte-macrophage colony-stimulating factor blockade), … Address correspondence to Dr. E. Brouwer, Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands. E-mail: e.brouwer{at}umcg.nl ER -