TY - JOUR T1 - Efficacy of Methotrexate in Real-world Management of Giant Cell Arteritis: A Case-control Study JF - The Journal of Rheumatology JO - J Rheumatol SP - 501 LP - 508 DO - 10.3899/jrheum.180429 VL - 46 IS - 5 AU - Matthew J. Koster AU - Karthik Yeruva AU - Cynthia S. Crowson AU - Francesco Muratore AU - Cristian Labarca AU - Kenneth J. Warrington Y1 - 2019/05/01 UR - http://www.jrheum.org/content/46/5/501.abstract N2 - Objective. To determine the effect of methotrexate (MTX) on relapse risk and glucocorticoid (GC) use in a large single-institution cohort of patients with giant cell arteritis (GCA).Methods. Patients diagnosed with GCA from 1998 to 2013 with confirmed evidence of temporal artery biopsy and/or radiographic evidence of large vessel vasculitis were identified. Each patient with GCA treated with adjunct MTX (case) was matched to a similar patient with GCA treated only with GC (control). GC requirements and relapse events before and after MTX initiation (or corresponding index date) were compared using rate ratios (RR).Results. Eighty-three cases and 83 controls were identified and compared. No significant differences in age, demographics, laboratory variables, baseline disease characteristics, or mean initial prednisone doses were observed. Median [interquartile range (IQR)] time from GCA diagnosis to MTX initiation in cases was 39 (13–80) weeks and the median (IQR) starting dose was 13.5 (10–15) mg/week. RR comparing relapse rates before and after MTX initiation/index date were significantly reduced in both cases (RR 0.32, 95% CI 0.24–0.41) and controls (RR 0.60, 95% CI 0.43–0.86). The decrease in relapse rate was significantly greater in patients taking MTX than in those taking GC alone (p = 0.004). Rates of GC discontinuation did not differ between groups.Conclusion. In this large single-institution cohort, the addition of MTX to GC decreased the rate of subsequent relapse by nearly 2-fold compared to patients taking GC alone. MTX may be considered as adjunct therapy in patients with GCA to decrease the risk of further relapse events. ER -