Methylprednisolone pulses are associated with faster remission in Giant Cell Arteritis: a multicentre inception cohort study

Despite being the cornerstone of induction therapy in Giant Cell Arteritis (GCA), glucocorticoisz (GCs) often fail to achieve sustained disease control and are associated with substantial morbidity, while evidence supporting the broader use of intravenous methylprednisolone (MP) pulses beyond high-risk patients remains limited and conflicting. We aimed to evaluate the effectiveness and safety of MP as induction therapy in newly diagnosed GCA. Retrospective, observational, multicentre study of patients with newly diagnosed GCA according to the 2022 ACR/EULAR classification criteria, comparing induction treatment with either MP or oral GCs. The primary outcome was time to remission. The effect of MP on time to remission was estimated using inverse probability weighted regression adjustment (IPWRA). A total of 206 patients were included; 116 (56.3%) received MP. Patients in the MP group more frequently had ischemic symptoms at onset. Overall, 196 patients (95.1%) achieved remission with a median time of 8.6 weeks (p = 0.287). IPWRA analysis showed that MP was associated with a shorter time to remission (average treatment effect, ATE: −14.2 weeks; 95% CI − 20.5 to − 7.8, p < 0.001). In adjusted Weibull regression, MP was associated with a higher hazard of remission (HR 2.44; 95% CI 1.66–3.59, p < 0.001). Patients treated with MP had a significantly lower median cumulative prednisone dose (733 vs. 1,902 mg; p < 0.001) and lower average daily prednisone dose until remission (13.6 vs. 30 mg; p < 0.001). At 3 months, the MP group required lower daily and cumulative prednisone doses and had fewer cases of diabetes mellitus and osteoporosis. In this real-world multicentre cohort, MP during induction were associated with faster remission and significant glucocorticoid sparing without increased short-term toxicity. These findings support reconsideration of the role of MP beyond patients with ischemic manifestations and warrant prospective confirmation.